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Preface
T he Thai Health Working Group is proud to release the
sixth issue of Thai Health. The working group has
received positive feedback from many organizations, many
occupations, and all age groups. The material has been
presented at various forums, and has been used for
organizing activities in villages and communities. The
feedback we have received encourages us to continue.
Human Trafficking?
9. AIDS Threats Thai Youth Because of Unsafe Sex 68
10. The First Steps of the National Health Assembly: 72
References 114
The Process of Writing the Thai Health Report 2009 122
Name of Steerings 124
Name of Experts 125
Name of Experts Health Indicators 125
Special Advisor 125
The Thai Health Report Team 125
areas and between cities where social, economic and political differences exist. Health
providers and medical technologies are highly concentrated in big cities rather than small
towns and rural communities. The government should take measures to strengthen the
motivation and status of health providers working in disadvantaged rural communities.
At the same time, the government should conduct cost-benefit analyses of medical
technologies, particularly diagnostic and therapeutic, including cost and distribution.
The quality and safety of health care, including incidences of medical errors, is an
important factor in the survival of patients. Statistics from hospital records reveal that 35
percent of deaths in the hospitals result from medical errors. About half of the errors can
be prevented. The most common cause of death in the hospital is hospital-acquired
infections or nosocomial infections. Emphasis should be placed on improving adherence
to hospital-acquired infections standard.
National health expenditures have increased significantly, from 147,837 million baht in
1995 to 248,079 million baht in 2005. Curative care accounts for about three quarters
of total health expenditures, compared to only 5 percent for prevention and health
promotion. The proportion invested in health promotion and disease prevention
programs should be increased.
Thailand has a relatively good health information system, which leads, to
some extent, to evidence-based policy formulation. However, improvement in the
information system is needed, particularly in relation to the coverage and
timeliness of data.
80 Northeast
60 740 people per bed
40 Central
388 people per bed
20
0
Bangkok Central North South Northeast
Private Sector 66.9 30.1 20.2 15.4 11.4
Local administration 7.3 0.0 0.4 0.0 0.0 Bangkok
State enterprises 4.0 1.7 0.0 0.5 0.0 223 people per bed
Other ministries 12.1 6.2 6.0 6.1 4.1
MoPH 9.7 62.0 73.4 78.0 84.5 South
Source: Thailand Health Profile 2005-2007 498 people per bed
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
224-381
Source: Thailand Health Profile 2005-2007 396-504
506-591
593-766
794-1,135
5
69,331 Community primary health care centres 0 200 400 600 800 1,000 1,200
Note: Population
while The
thoseprovinces
provinceswith
withmore
fewerbeds
bedsperwillthealso
Source: Thailand Health Profile 2005-2007 population will inpatients.
have more inpatients, per bed
have fewer ratio
Source: Thailand Health Profile 2005-2007
Nevertheless, the Thai government has been increasing the number of future doctors to
solve the HRH shortage problem. In 2006, more medical, dental and nursing students were
recruited into the education system. There was an increase in the number of medical
students by about 50 percent from 2002.
Despite the future increase in the number of medical staff, the distribution of HRH has
been found inequitable, particularly the inequitable distribution between rural and urban
areas. The poor and remote area in the Northeast of Thailand where the majority of the
country resides has the highest ratio of population per one health personnel. In 2004, the
ratios of population per doctor, per dentist, per pharmacist and per nurse of the Northeast
region were 8.5, 4.4, 2.8 and 3.6 times higher than those of Bangkok, respectively.
In relation to work settings, the majority of HRH work under the Ministry of Public Health,
except pharmacists. The proportion of pharmacists working in private sector was slightly
higher than that of the public sector (54 percent).
To attract and retain HRH working in rural and public facilities, the government has
implemented ranges of measures. Increase the HRH production is among the measures used
by the government. The implementation of local recruitment, local training and hometown
placement approach has been initiated in which students recruited locally, train at local
academic institutes and are posted near to their hometown after graduation. Compulsory
public service has been seen as important measure to increase HRH in rural areas. In this
approach, HRH were compelled to serve the public for 2-4 years after graduation. If they
beach the contract, they are fined. This combined with various forms of incentives that have
been implemented, such as, financial awards and career advancement schemes has resulted in
an improvement of the HRH distribution, particularly in rural areas.
481 324
18,563 13,129
1,036 754
90 General hospital
2,643
of total new entry in 1999-2005 80
70 District hospital
50 60
percentage
2,460
45 Dentists 45.03 50
Physicians 40
Pharmacists
1,602
40
2,649
30
29,508
Nurses 43.66
3,523
35 20
10
30 0
percentage
26.00
25.59 ns ts sts ses
25 h y sicia D entis harmaci Nur
19.58 P P
20 21.58 Source: Report on Health Resources 2006, Bureau of Health Policy
17.41 and Plan cited in Thailand Health Profile 2005-2007
15 16.68
9.17 10.16 Population per health workforce in 1987, 1997 and 2006
10 6.86 8.76
5 9.37 9.90 40,000
5.57 5.10
0 35,000
1999 2000 2001 2002 25003 2004 2005 30,000
36,516
1987 1997 2006
17,711
Source: Personnel Division, Office of Permanent Secretary for Public 25,000
Health cited in Thailand Health Profile 2005-2007
14,800
20,000
10,178
15,000
7,862
7,340
Annual production capacity of Health workforce
5,595
3,649
2,965
10,000
in 2004 2005 and 2006
1,743
1,073
617
5,000
9,000
7,770
4,000 4
3,000
2,179
3
1,577
1,482
2,000
1,417
1,349
1,000 2
793
502
478
Singapore
0 Malaysia
Physicians Dentists Pharmacists Nurses 1
Thailand
Source: Thailand Health Profile 2005-2007 Vietnam
0
0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000
GDP per capita
Source: World Development Indicator 2002 and World Health Report 2006
Geographical distribution of Health workforce in 2007
Source: Report on Health Resources 2004, Bureau of Health Policy and Plan, MOPH
80 estimate VR
70 30
60
25
50
40 20
30
15
20
10 10
0 Year
5
1970
1975
1980
1985
1990
1995
2000
2005
Vital registration 0
us D ers nonle ries ned
Census 1990-indirect ctio CV anc huenricab inju defi
Census-indirect ll I
nfe All All
C o t l l
SPC 1985-direct A Acollmm A
SPC 1985-indirect
SPC 1995-direct Source: Porapakkham, Y. et al. 2008
SPC 1985-indirect
DHS 1987-direct Note: A verbal autopsy is a method of finding out the
Predicted cause of a death based on an interview with next of
kin or other caregivers.
Source: Hill, K. et al. 2008
Maternal death by source of data, 1930-2010 Broad causes of death from VR and VA estimated:
female, Thailand,2005
900
50
800
700 35
estimate VR 15
600 40
MMR
500
35
400
300 30
200 25
100
Year 20
0
1930
1940
1950
1960
1970
1980
1990
2000
2010
15
VR 10
RAMOS
Safe Motherhood 5
UNFPA
TDRI 0 s
WHO ctiou C VD ancers one
enricnabl n juri
es
defi
ned
Infe All ll C t
ouh
All
i
Source: Vapattanapong, P. 2008 All A Acollmm
Number of surveys from surveillance, health records and administrative Source: Porapakkham, Y. et al. 2008
records where information about health and indicators of health inequity are available
Health Coverage or Health care Quality and Health Health
financing availability utilization responsiveness status risk
Geographic 3-0-2 4-1-3 11-8-3 2-0-0 11-10-3 10-6-1
(Province, urban vs. rural)
Demographic
(Sex, age group) 3-0-2 4-0-2 12-8-2 2-0-0 12-9-2 11-5-0
Social 3-0-2 4-0-2 10-4-2 2-0-0 11-5-2 11-4-0
Eduation, occupation)
Economic (Wealth, 3-0-0 4-0-0 7-1-0 2-0-0 9-1-0 7-1-0
income, consumption)
Source: Tangcharoensathien, V. et al. 2007 Notes: The first number in each cell represents the number of surveys from the surveillance system,
the second number in the cell represents the number of surveys within health records and the final
number represents the number of surveys from administration records.
86
30,000
45
26,5
Number of CT scanner by region, 2006
88
24,1
23,0
96
25,000
34
46
08
05
20,9
28
19,0
20
30,5
19,6
29,7
16,1
18,1
20,000 North
25
821
26,0
4 units per
15,
15,000 Northeast
68
68
1 million people
19,8
00
19,9
10,000 9,276 2.2 units per
16,7
32
47
14,2 1 million people
14,1
67
76
13,4
5,000
10,6
0 Year
5
5
199
199
199
199
199
200
200
200
200
200
200
Source: Thailand Health Profile 2005-2007
50.2
18,000 7.4 units per
16,7
30.1
99.1
16,000
14,9
1 million people
15,7
Export Import
73.1
Values
34.5
14,000 Values
35.3
60.5
11,9
11,9
15,0
55.1
12,000
10,8
2.5
13,0
.2
9,54
,953
10,000 Bangkok
.1
90.2
8
9.3 7,670
8,000
3.4
10,0
.2
4.8
6,75
2.0
1 million people
1.8 5,860
1.9
5,89
44.1
9,33
8,84
8,46
6,000
8 5,1
17.8
7,00
South
7.6
1992 3,245 3,4
4,000 93.2
1.8
8.7
.1
5,60
5,45
2,4
5.6
5,18
4,72
4,39
2,000 .1
.5
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
1979
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Private Bangkok
282 units 30 units
Bangkok 82.2% 66.7% Government
115 units 15 units
Regional 33.5% Private 33.3%
228 units Regional 30 units
66.5% 15 units 66.7%
Government
61 units 33.3%
17.8%
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
IP OP Home H Care+Medical Goods
0.0 P&P H admin Capital
1994
1996
2004
2001
2002
2004
2008
2010
2012
2014
2016
2018
2020
2022
2024
2026
Source: National Health Accounts in Thailand, 1994-2005
Source: Scholz W et al, 2008 IP = Inpatient services P&P = Prevention and public health services
OP = Outpatient services H admin = Health administration and health insurance
Home H care+Medical Goods = Medical goods Capital = Gross capital formation
MOPH = Minister of Public Health SocSec = Social Security Scheme StateEnterprise = State Enterprise dispensed to out-patients
OthMin = Other Ministries UC = Universal Health Care Coverage CSMBS = Civil Servant Medical Benefit Scheme
LocGovt = Local Government MOPH = Minister of Public Health SocSec = Social Security Scheme
StateEnterprise = State Enterprise OthMin = Other Ministries UC = Universal Health Care Coverage
CSMBS = Civil Servant Medical Benefit Scheme LocGovt = Local Government
Projected costs of the National Access to Antiretoviral Program
It is important to note that expenditure on CSMBS increased by 26 percent between 2006 and 2008.
This escalation intensified inequity of the government subsidy among the three public schemes.
for People Living with HIV/ AIDS (NAPHA), 2001-2025
NAPHA Policy 2001 2005 2010 2015 2020 2025
Budget analysis of universal access 1 year
st
4 year
th
16 year
th ART cost 10.9 130.8 355.4 483.4 507.0 477.0
to renal replacement therapy (assuming 2004) (assuming 2007) (assuming 2020) (million in 2004 USD)
Estimated budget on RRT for all ESRD AIDS budget 37.2 67.2 55.2 71.2 91.7 118.1
(million in 2004 USD)
patients, using unit cost at 350,000
baht/patient/year (million baht) Health budget 1,130.7 1,253.7 1,623.0 2,101.2 2,720.3 3,521.7
(million in 2004 USD)
As % of total UC budget ART as a share 29% 195% 644% 679% 553% 404%
As % of total health expenditure of AIDS budget 19
Source: Kasemsap V., Prakongsai P. and Tangcharoensathien V., 2005 ART as a share 1% 10% 22% 23% 19% 14%
of the health budget
Source: Revenga A. et al., 2006
Total Health Expenditure (THE), 1995-2005
Indicator 1995 … 2001 2002 2003 2004 2005
THE, million baht 147,837 … 170,203 200,768 210,368 225,652 248,079
THE, % of GDP 3.53 … 3.32 3.68 3.55 3.47 3.49
Public Financing Agencies, % 47 … 56 63 63 64 64
Out-of-pocket, % 43 … 33 28 25 26 27
Other Private Financing Agencies, % 10 … 11 9 12 10 9
THE, Baht per capita 2,486 … 2,732 3,197 3,335 3,641 3,974
THE, USD per capita 100 … 61 74 80 90 98
Exchange rate (baht/USD) 24.9 … 44.5 43.0 41.5 40.3 40.3
Source: National Health Accounts in Thailand, 1994-2005
Expenditure of Civil Servant Medical Benefit Scheme during 1989 and 2008
70,000
40%
60,000 33%
26% 26%
50,000 23% 26% 30%
19% 22% 26%
million Baht
20,000 OP IP
0% Total Growth rate
10,000
-7% -10% Note: * Expenditure for 2008 is extrapolated from
0 6 months actual spending
2008*
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Over the last three decades Thailand has improved its coverage of essential health services
and interventions for Thais. The improvements in coverage have been in essential vaccines,
antiretroviral drugs (ARVs) for HIV/AIDS patients, sustainable condom use by female sex
workers, and emergency medical services. However, there is still low coverage for
screening cervical cancer, screening and access to appropriate medical care for
hypertension, diabetics and hyperlipidemia and poor coverage of helmet and safety belt
use.
The national immunization coverage in Thailand for all types of vaccine has been high for
a number of years. The coverage in 2002 was 98 percent for BCG, 90 percent for DPT
and OPV, 84 percent for measles, while the lowest rate was for tetanus toxoid for
pregnant women, in which the coverage was only 75 percent. Hepatitis B3 vaccine, which
was introduced only in late 1992, has reached almost 90 percent of children since 1996.
As a result of such high immunization coverage, the morbidity rates of such preventable
diseases have declined.
Since October 2003, the Ministry of Public Health has also implemented the policy on
universal access to ARVs by providing all HIV/AIDS patients who need them with ARVs
through the expansion of the Universal Coverage benefit package. The coverage of ARVs has
increased significantly from approximately 2,000 cases in 2000 to more than 100,000 cases
in 2006, and exceeded 125,000 cases in 2007 after the compulsory licensing measure was
introduced. Currently, Thailand focuses on both treatment and prevention, for example a
campaign to promote condoms has increased condom use among adolescents, although the
rate among female adolescents is still low.
Weaknesses within the Thai health system includes: a lack of screening for diseases and the
existence of a high number of patients who have never had any diagnosis, particularly for
hypertension, hypercholesterolemia, diabetics and cervical cancer.
100
Percentage coverage
80
60 BCG
DPT
40 OPV
Measles
20 Hep B3
TT pregnant woman
0 Year
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Source: Modified from Thailand Health Profile, 2005-2007
BCG = BCG tuberculosis vaccine
DPT = diphtheria, pertussis, and tetanus (DPT)
OPV = Oral Polio Vaccine (OPV)
Proportion of Hepatitis
Hep B3= drivers B 3 aged 14 years and over using safety belts from 1991 to 2006
TT pregnant women = Tetanus toxoid for pregnant women (TT)
Use of safety belt
1991
1996
2000
2001
2003
2006
Vehicles with safety belts
Constantly used
4.3
35.8
25.9
27.1
23.5
31.3
21
Occasional used
11.7
28.0
32.2
44.2
39.7
45.2
Never used
12.6
6.3
13.9
12.1
32.2
21.9
Vehicles without safety belts
64.6
29.9
--
4.4
2.4
1.6
Source: Health and Welfare Surveys in various years
Proportion of motorcyclists aged 14 years and over using helmets from 1991 to 2006
Use of helmets
1991
1996
2000
2001
2003
2006
Constantly use
7.2
29.0
32.0
16.1
16.0
18.6
Occasional use
21.7
55.4
44.2
64.3
49.5
59.7
Never use
11.0
6.0
15.8
10.3
32.8
21.7
No helmet
59.8
9.3
--
9.1
--
--
Source: Health and Welfare Surveys in various years
Number of HIV patients receiving antiretroviral Proportion of those not diagnosed and diagnosed with
drugs (ARVs) from 2000 to 2007 hypertension, hypercholesterolemia and diabetics
Compulsory
licensing Hypertension
males
Hypertension
females
Treated and controlled Cholesterol
Include ART males
in UC package
Cholesterol
females
Generic
production Treated and controlled
Diabetic
of triple ART males
Diabetic
females
Treated and controlled Awareness but not being treated
Treated but uncontrolled Never been diagnosed
Source: Wibulpolprasert S., 2008 Source: National health examination survey III, 2004
40,000
30,000
20,000
10,000
0
5
06
05
07
08
06
6
7
r05
y05
05
v05
r06
y06
v06
r07
y07
07
v07
r08
y08
Jul0
Jul0
Jul0
Jan
Jan
Jan
Jan
Sep
Sep
Sep
Ma
Ma
Ma
Ma
Ma
No
Ma
No
Ma
No
Ma
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
20
0 Source: Tangcharoensathien V., 2008
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
10 120
8 95
90 85
6
Minutes
60 48 54
4 45 47
37 40
2 30
0
The Universal Civil Servant Social 0
Thai
Victoria
NSW
Spain
Swiss
Finland
Israel
Saudi
Coverage Medical Security Scheme
Benefit Scheme
2.90 9.93 6.45 % Removal of
coronary obstruction Source: The Heart Association of Thailand under the Royal Patronage, 2006
0.13 0.46 0.18 % Coronary bypass
Source: Faramnuayphol P., 2006
18 17.0
18
12.9 <=60 15
12 10.4 9.8 10.4 61-120 13.1 12.6
7.8 8.2 7.5 7.4 12
121-180
6 >180 9 7.0 25
0 Total
Door to needle time, min onset to thrombolytic time, min 6 5.0 4.9
3.0 3.0
Source: The Heart Association of Thailand under the Royal Patronage, 2006 3
0
Percentage in-patient death due to adverse events STEMI NSTEMI UA Overall
Source: The Heart Association of Thailand under the Royal Patronage, 2006.
Occurrence No. % of 279 (95%CI)
AE 98 35.1 (29.5-40.8) Note: GRACE is the Global Registry of Acute Coronary Events
Drug AE 7 2.5 (0.7-4.4)
AE Death 43 15.4 (11.1-19.7)
Preventable 53 19.0 (14.4-23.6)
Source: Kessombon P. et al., 2005 Case fatality rate in ACS patients with and
without CAG test
Type of adverse events 30
25.5 CAG: not done
Item Climical conditions* No. (%) 24 CAG: done
1 Nosocomial infection 86 (30.5) 17.6
2 Death 53 (19.0) 18 16.8
Dead %
Thailand has made marked improvements in health equity due to the expansion of the
health insurance coverage provided by the three major public health insurance schemes.
The Civil Servant Medical Benefit Scheme covers around six million government employees
and their dependants; the Social Security Scheme protects approximately nine million
employees in the formal sector from non-work related health care expenditure; and the
Universal Coverage scheme covering approximately 47 million people (~75 percent of the
entire population) who were not previously beneficiaries of the Civil Servant Medical
Benefit Scheme or the Social Security Scheme.
During 1992-2006 the poorest decile of Thai households spent, on average, a higher
percentage of their household income than the richest decile. Nevertheless, inequity in
health spending has improved because the proportion of household spending on health to
income of the poorest (first) decile significantly decreased from 8.17 percent in 1992 to
2.23 percent in 2004, whilst that of the richest decile has slightly decreased from 1.27
percent in 1992 to 1.07 percent in 2004.
The pattern of health service use also indicates greater equity. For instance, the increase in
utilization of primary care and secondary care levels of the lower income quintiles lead to a
significant improvement of equity in ambulatory service use.
Despite the above mentioned improvements within the Thai health system inequalities still
exist between different socio-economic groups. The rich-poor mortality gap in under-five
mortality rates (U5MR) still occurs. Furthermore, the survey of self-reported health assessment
by the National statistical Office and International Health Policy Program, Thailand has revealed
approximately two-thirds of the poorest quintile was affected by physical and mental health
problems, which was significantly higher than that of the wealthiest Thais.
50.0
40.8
mortality rate per 1000 live births
40.0
32.3
30.0 24.9 23.0 Poorest quintile
19.1 19.2 19.3
20.0 14.8 14.7 Quintile 2
12.9
Quintile 3
10.0
Quintile 4
0.0 Richest quintiles
1990 census 2000 census
Source: Vapattanawong P. et al., 2007.
Percentage of live births below 2500 grams by residential Hospitalization by different types of health facility
areas and economic status of Thais, 2005-2006 and by income quintile in 2001 and 2003
percent
12 0.100
10 0.090 0.01 0.01
10 9.5 9.3 9.4 9.6
Hosptial admission per cap per year
Urban
Rural
Poorest
Middle
Wealthy
Wealthiest
(include
Bangkok)
Central
Poor
52-07-053_001-031_V.indd 28 7/15/09 5:14:32 PM
Historical development of achieving Incidence of catastrophic health expenditure by types
universal coverage from 1945 to 2001 of health care prior to and after Universal Coverage
31.0% Self-medication
User fees
1945 Outpatient care only
Informal exemption With inpatient care
1970 1975 1980 Establishment of
LIC CSMBS prepayment schemes
1983 1990 15.1% 14.6%
1-3rd NHP 1980 CHF SSS Expansion of 12.0%
1962-76 prepayment schemes
Provincial 79% 8.3%
hospitals SSS CSMBS
1990
LIC MWS 1994 2.1%
4th-5th NHP Universal 0.4% 0.6%
PVHI
(1977-86)
District hospitals SSS Coverage 2000 2002 2004
Health centers 2000
CSMBS Source: Limwattananon S, Tangcharoensathien V, and Prakongsai P. 2007.
2001
Universal Coverage
Health Infrastructure
2001
3.8% 4.3%
1.7%
2.6%
1.7% 1.5%
0.3%
0.3%
3.7% 2.8% 1.4% 0.6% 15.1% 1.7% 0.7% 0.8% 1.9% 1.0% 0.7% 1.0%
No Self- Op with No Self- Op with No Self- Op with Post-OOP improverished
Care med care IP Care med care IP Care med care IP Pre-OOP improverished
only care only care only care
2000 2002 2004
million Baht
140 * * * * **
* * * 25,000
120 * * * * * * ** * *
100 * * 20,000
80 * * * * 15,000
* ** ** ** ** * * * * * * ** 10,000
60 *
40 * * * * ************ * * ****** * * 5,000
20 * *Thailand******* ******** ****** * * * * * **
** * *** 0 Year
0 * * * ******* ***** * *
2533
2535
2539
2541
2537
2543
2545
2549
2547
25 50 100 250 500 1000 2500 5000
THE per capita (PPP dollars) Source: International Health Policy Program, 2008
Source: Limwattananon S. analyzed from the World Health Survey (WHS) data, WHO
Thirty low-income countries with the highest average yearly rate of reduction in mortality rate among children aged under 5 years
from 1990 to 2006
Countries
Total Population
Average yearly Mortality rate for Number of deaths Estimated maternal
reduction
children < 5 years + for children < 5
and
in thousands
in mortality
mortality ratio
Territortes *
(2006)
(1990-2006)
(2006)
years (2006)
(2005) #
1
Thailand
63444
8.5%
8
7000
110
2
Vietnam
86206
7.1%
17
28000
150
3
Peru
27589
7.1%
25
15000
240
4
Brazil
189323
6.5%
20
74000
110
5
Indonesia
228864
6.2%
34
151000
410
6
Syria
19408
6.0%
14
7000
130
31
7
Egypt
74166
5.6%
35
64000
130
8
Sri Lanka
19207
5.5%
13
4000
58
9
Nepal
24641
5.5%
59
47000
830
10
Morocco
30853
5.5%
37
23000
240
11
El Salvador
6762
5.5%
25
4000
170
12
Ecuador
13202
5.4%
24
7000
210
13
Turisia
10215
5.1%
23
4000
100
14
Dominican 9615
5.0%
29
7000
150
Republic
15
Laos
5759
4.9%
75
12000
660
16
Bangladesh
155991
4.8%
69
277000
570
17
Honduras
6969
4.8%
27
5000
280
18
Iran
70270
4.7%
34
48000
140
19
Bolivia
9354
4.5%
61
16000
290
20
Kazakhstan
15314
4.5%
29
8000
140
21
Eritrea
4692
4.3%
74
14000
450
22
Guatemala
13029
4.3%
41
18000
290
23
Philippines
86264
4.1%
32
73000
230
24
Turkmenistan
4899
4.1%
51
6000
130
25
Haiti
9446
4.0%
80
22000
670
26
Nicaragua
5532
4.0%
36
5000
170
27
Paraguay
6016
3.9%
22
3000
150
28
China
1320864
3.9%
24
415000
45
29
Cuba
11267
3.9%
7
1000
45
30
Malawi
13571
3.8%
120
68000
1100
Total
2545732
1433000
Countries are ranked according to progress for Millennium Development Goal4. *Countries with Gross National Income greater than US$5000 per person and less than
100 000 births per year were excluded.
+ Per 1000.
# Per 100 000.
Human trafficking?
AIDS threats Thai youth because of unsafe sex
The first steps of the National Health Assembly:
cannot solve the political conflicts which occurred the PAD publicly announced that they would stage the
before and after the military coup. The confrontation mass protest at Nong Prachaksilapakom public park in
will persist and will have a great impact on politics for Udonthani province. A local protest group named “kon
many years to come. The two camps will use whatever rak udon or we love Udon” turned out and clashed
means to fight against one another with no with the PAD protestors, resulting in many injured.
compromise and may become so extreme that they Although the brutal scenes were released and televised
may eventually turn to civil war. The most important nationwide, there was even more violence in many
question right now is that how we can prevent a civil part of the country, including Bangkok.
war from breaking out.
Human Rights Watch, the international human rights
Since then, a yellow shirt and a hand-like clapper has organization, has condemned the Thai government and
become the distinctive symbol of the PAD, and the government officials who turned a blind eye to the
ASTV has become their communication television violence which has erupted from time to time.
channel. Meanwhile the UDD has used a red shirt and Similarly Thai intellectuals have publicly criticized the 35
a foot-like clapper as their symbols with their violence. However, it seems as if the confrontation has
television program “the truth today” televised on
become so deep that no one listens to any criticism.
the public television channel 11, as their main People were waiting for violence to erupt, even though
communication channel. The UDD has expanded its the PAD always claimed that they had strictly
alliance into a wider movement, not merely to support observed a non-violent strategy. On 26 August 2008
Mr. Thaksin as originally staged, but also to include the PAD began satellite rallies in several places,
the redrafting of the constitution and democracy and notably with the seizure of the National Broadcasting
power.
Authority of Thailand (NBT) or formerly the public TV
Fueling violence
channel 11. The protests were widely publicized in all
media. There were pictures apparently of the arrest of
The prolonged street protest against the government protestors and various kinds of weapons including
by the PAD has worried many Thais after the Prime wooden stick, knives, guns, and metal bullets. On the
Minister, Mr. Samak Sundaravej, appeared on the same day, the government was expelled from its office
television on 31 May 2008 announcing that his after the PAD had taken control of the government
government would take tough action to clack down the house.
protestors. This resulted in a huge turnout of people to
join the PAD amidst the volatile situation. Mr. Parinya Finally, the government declared on 2 September
Thaewanaruemitkul from Thammasat University 2008 a state of emergency in Bangkok. This followed a
together with many groups had described themselves clash between the UDD and PAD on Radchadamnoen
as “white power” and acclaimed that it is acceptable Avenue, which left one dead and at least 40 injured.
if people have different ideas, but violence is Another incident of violence erupted in Chiang Mai
unacceptable. Government moves to clamp down on where the red group attacked and later killed a father
protestors were later downgraded where instead the of a PAD member from the province. This incident
police officers were sent to negotiate with protestors shocked the residents of Chiang Mai province
firm and refuse to step back, driving the country into a peace dialogue.
a dark situation leaving no way out. What no longer
exists in Thai society is a middle ground between the At the same time the Rule of Law Thailand network
two ideologies. In the end, whatever side wins or led by Mr. Thanet Arpornsuwan, Dean of Arts Faculty
loses, the damage to the country will be complete and of Thammasat University, called for the public to stop
all that will remain are ruins.
three things: (1) stop organizing and bringing out
people to confront each other, (2) stop supporting the
Such statements turned out to be true when the PAD, (3) stop bringing Thailand towards anarchy and
journalists were attacked while on duty reporting the military coups.
from the yellow-clad or PAD to the red-clad or UDD. comes the extremism on both sides. He predicted
Thai society has divided and the conflict has deepened that it is likely that Thai society may face political
for the last 3 years. Various organizations and social atrocities with hunting and killing of suspected enemies.
critics have together urged the public to join hands in Thus the country may face severe confrontation.
opening an area without taking side where people can The way to avoid confronting extremisms is to
exchange their ideas. The government suggested the increase the maturity and courage of all sides,
King Prachathipok Institute as a neutral place to take leading to negotiation, compromise, responsibility,
the lead in political reform. The opposition party also and willingness to forgive previous wrongdoing.
approved the move, hoping to restore national unity
Timeline of key events between September 2004 and February 2009
Protesters demanded Police Lieutenant Colonel Thaksin Shinawatra step down. A crowd gathered at
25 September 2004
the Royal Grounds and then proceeded to the central business district. Some people agreed with and
others opposed the move. The protests lasted for years and ended after the military coup.
19 September 2006
A military coup took place to oust the government led by Police Lieutenant Colonel Thaksin Shinawatra
30 May 2007
The Constitutional Court ordered the dissolution of Thai Rak Thai party
22 July 2007
A clash between the Democratic Alliance Against Dictatorship (DAAD) and polices in front of General
Prem Tinsuranond’s residence
19 August 2007
A national referendum on Thailand’s draft constitution was accepted (58 percent agree and 42 percent
disagree, and invalid votes accounted for about 2 percent)
38
23 December 2007
The People Power Party won the general election and Mr. Samak Sundaravej, the party leader sworn in
as the prime minister on 6 February 2008 (He ended his premiership on 18 September 2008)
The People’s Alliance for Democract (PAD) started a protest demanding that Samak step down, occupied
25 May 2008
the government house since June, and rallied at many public places to put pressure on the prime
minister
26 August 2008
PAD seized the government NBT television station, blockaded three ministry compounds, and occupied
Government House
2 September 2008
Clashes between DAAD and PAD left one person dead and about 40 injured. As a result Mr. Somchai
Wongsawat had ordered the state of emergency in Bangkok
9 September 2008
The Constitution Court disqualified Mr. Samak Sundaravej after finding him violating the charter as an
employee of a private company hosting cooking show program “Munching Talking”
17 September 2008
Mr. Somchai Wongsawat sworn in as a prime minister (ended on 2 December 2008 after the People
Power Party was dissolved)
7 October 2008
Police fired tear gas into the crowd of protestors in front of the parliament house, leaving 612 injured
and 3 dead
23-26 November PAD led protestors blocked the government’s temporary office at Don muang Airport, demanded that
2008
Prime Minister Somchai Wongsawong resign and marched to close Suvarnabhumi Airport on 26
November
2 December 2008
The Constitutional Court’s dissolved the People Power Party based on election fraud
3 December 2008
PAD put an end to its protesting
15 December 2008
Special National Assembly convened and selected Mr. Abhisit Vejjajiva, the leader of the Democrat party,
as the prime minister
31 January 2009
Leaders of the UDD gathered at the royal ground and led the protestors to blockage the government
house demanding an immediate resignation of Mr. Abhisit Vejajiva.
political weakness
T he reemergence of narcotic drugs
as a serious social problem can be
seen from the fact that in 2008 there
were as many as 203,728 drug
offences recorded by the police.
Concerns have been widely raised that
drug users are getting younger and
younger. A survey on the prevalence of
drug use in Thai households revealed
that during the period between late 2007
This policy aimed to eliminate drugs within three
and early 2009, children and young people months (1 February to 30 April 2003) by implementing
in particular have become the preferred tough measures against drug dealers. The government
target for the spread of methamphetamines. claimed that drug abuse was a serious threat to
Bangkok was found to have a greater variety the country and that drug crimes were having an 39
of drugs than other regions.
enormous impact on society.
The implementation of this anti-drug policy resulted
the government led by Prime Minister Thaksin to early 2007. Similar downward trends were also
Shinawatra launched the “war against drugs” policy. observed for the annual number of drug crimes, which
fell about 53 percent between 2002 and 2003.
However, annual drug crimes bounced back rapidly
Figureรูป1จํ
Number of drug
านวนคดี crimesดbetween
ยาเสพติ 1998 and 2008
พศ between 2005 and 2008 and reached well over
200,000 cases annually, or about as many as the
recorded cases during 1998 to 2002 (see figure 1).
This high prevalence in 2008 to early 2009 reflects
OVNCFS
to some extent the reemergence of drug abuse
particularly methamphetamine.
ZFBS
Reemergence of drug abuse due to political
weakness
2007
9,733
stated that the current political instability is the most
important barrier to overcoming drug problems.
2008
11,671
Source: Department of Juvenile Protection, Ministry of Justice
Squadron Leader Dr. Boonreung Trireungworarat,
40
[http://www2.djop.moj.go.th/stat/show_stat.php]
Deputy Director of the Medical Science Department,
In early 2008, Police Major General Udom stated that the estimated number of drug addicts
Raksiladham, Deputy Commissioner of the Narcotic in 2008 was about 500,000. Of this total, about 70
Suppression Bureau, indicated that drug trafficking percent or 300,000-400,000 people were the drug
often occurs during the festival seasons when there addicts. Methamphetamine was the most popular
are many people traveling from place to place. In drugs.
these circumstances, drug traffickers can easily Dr. Wasin Bumrungcheeb, a psychologist specializing
disguise themselves. In October 2008, Police Major in alcohol and drug addiction at Manarom hospital, a
General Udon Narongsak, Chief Commander of Chiang private psychiatric hospital, has argued that drug
Rai Police, reported that approximately 53 factories problems will become more serious for seven reasons.
established along the border in Chiang Rai province (1) A n economic downturn leads to increases in
continue to produce methamphetamine to supply the unemployment, with in turn increases the number
Thai market. It is expected that the methamphetamine of drug sellers
will be continue to be trafficked into the country.
(2) T he price of drugs become cheaper and drugs
The market price of methamphetamine reflects
become more widely available
how well the problems have been tackled by the (3) Youth and the public regard drugs as normal
government officials. Police Colonel Dusadee
Arayavud, Deputy Commissioner of Department of (4) Marketing strategies are used to attract consumers
Special Investigation, reported that the success of (5) Current social circumstances leave parents little
methamphetamine control can be judged by its market time to raise their children appropriately
price. During the 3-4 years when the war on drugs (6) Inappropriate child raising leads to lack of self
policy was being implemented, the market price of one discipline, making people vulnerable to drug abuse
methamphetamine pill was around 300-400 baht (7) D iscontinuation of drug control policy due to
while the cost at the production site was only 40 baht political instability
per pill. Nowadays, methamphetamine is trading
they would remain significant in the coming years. of crimes committed by children and young people
Based on ONCB’s records, from January to June 2008 involving in drug abuse during the months of January
there were 62,409 reported drug crimes involving to November 2008 was 10,208. Out of this, 5,900
67,185
รูปรูปจํ
จํา จํpersons.
รูานวนคดี
ปนวนคดี านวนคดี
ย ย
าเสพติ Theยดาเสพติ
าเสพติ most
ด affected
ดพศ
พศ
พศ areas include cases, or about 58 percent, involved methamphe-
Bangkok, provinces in the Central and Northeastern tamines. Methamphetamine crimes were the leading
regions.
The
most
vulnerable
populations were people crime committed by children and young people.
aged 15-24 years, unemployed people, and low-paid
The situation in Prachaubkirikhan Province is
workers. The upward trends in recorded
drug crimes representative of the current state of the epidemic.
OVNCFS
OVNCFS
OVNCFS
indicated the rise drugs abuse and the severity of the Mr. Panchai Bowornratanapran, the Governor of
problems.
Prachaubkirikhan province, has declared a curfew
Miss Suwannee Khammun,
Deputy
Secretary General after learning that methamphetamine has been spread
of the National Economic and Social Development ZFBS
ZFBS
in the province. Young people under 18 years of ages
ZFBS 41
Board (NESDB) has argued that the social situation in are not allowed to go out alone after 22.00 hours.
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52-07-053_032-079new17_V-eng.ind41 41 7/17/09 9:15:39 AM
The Research Unit for the Studies of Drug and Its
Social Consequences, Social Research Institute,
Chulalongkorn University, conducted research
investigating drug use among young people at Juvenile
Observation and Protection Centre in four provinces.
female than male youth (Figures 2 and 3)
Data from the Tunyarak Institute, which is one of five
government drug treatment centres, show that the
ZFBS drug addicts who received treatment during the period
of 2003-2007, 80 percent were male (figure 4), and
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Commander of the Royal Thai Police, there have been worsened in 2009 as more than 100,000 persons
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reductions in all types of crime in 2008, except for have'JHVSF1SPQPSUJPOPGNPTUDPNNPO been laid off work only in the first two months.
gun and drugs 'JHVSF0DDVQBUJPOPGDIJMESFO
crimes, which have risen significantly.
BOEZPVUICFGPSFBSSFTUFE The unemployed
ESVHVTFCZTFY will be hit hard and as a result some
After the Prime Minister Thaksin Shinawatra launched of them might turn into drugs.
3BUDIBCVSJ/BLIPO1BUIPN+VWFOJMF0CTFSWBUJPOBOE1SPUFDUJPODFOUFS
his “war on drugs policy” in 2003-2005, over 2,500 Table2 Number of drug addicted at Thanyarak Institute
people were killed. Thisraised concerns of among according to
occupation
42 human rights groups internationally. Research Occupation
2003
2004
2005
2006
.BMF2007
conducted by Miss Manorat Supornsahatrungsri,
a Wage labor
851
1,348
1,654
1,400
'FNBMF1,122
student in the Economics Department, Thammasat Trade
F 283
B
282
298
366
442
Government QIFUBNJO .BSJKVBO97
.FUIBNservice
PMBUJMF
W119
143
&DUBDZ 111
147
University has indicated the critical issue for Thai
3BUDIBCVSJ
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237
67
62
25
48
/BLIPO1BUIPN
society is that drug sellers
have begun toBOE1SPUFDUJPODFOUFS
target Agriculture
110
108
134
$IPOCVSJ3BZPOH+VWFOJMF0CTFSWBUJPOBOE1SPUFDUJPODFOUFS87
101
children and young people in educational institutions. $IPOCVSJ3BZPOH Fishing
1
3
1
5
2
+VWFOJMF0CTFSWBUJPO
Education institutions have become a meeting and
BOE1SPUFDUJPODFOUFS Unemployed
1,601
1,273
1,496
1,390
1,606
selling places for drug users and dealers. Many Othere
64
68
66
107
.BMF564
students have become drug dealers themselves.
Not specified
133
33
21
0
'FNBMF 4
Total
3,377
3,302
3,875
3,491
4,036
Moreover, female students have become involved in Source: Thanyarak
IFUBNJOF BSJKVBOB WPMBUJMF
.FUIBNQ Institute.(http://www.thanyarak.go.th)
&DUBDZ
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use and addiction. Customers are becoming
younger and younger.
Concerns are being raised for how young Thais and
BNPOHZPVOHQFPQMFJOUIF+VWFOJMF0CTFSWBUJPOBOE1SPUFDUJPO$FOUSFTBOE+VWFOJMF7PDBUJPOBM5SBJOJOH$FOUSFT
<IUUQXXXBCBDQPMMBVFEVBDTBO@UIBJJOEFYIUNM> Thai society can proceed. The worsening drug situation
has impacted on all aspects of society including
'JHVSF/VNCFSPGESVHBEEJDUFEBUJO physical health, the family, the economy, and the
5IBOZBSBL*OTUJUVUFCFUXFFO development of the nation. The gloomy political climate
has slowed government efforts to curb drug problems
for over 2 years. The biggest gap in government
policy on drugs is strategies focusing on keeping
young people away drug selling and addiction.
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for other types of oil.
the then Minister of Energy, had few concrete
measures to deal with the oil crisis apart from a few
The consequences of rising oil prices was that small conventional ideas such as ordering public places
and retail gas stations in upcountry areas were hard to turn air-conditioners to 25 degree, take off suits
hit. Mr. Manoon Siriwan, an expert in energy and at the ministerial meeting, and limit speed of public
petrochemicals, stated that 2,000-3,000 small gas vehicles to 90 km per hour.
stations closed down and medium size stations
gradually reduced their investment in Thailand. Famine
Although large scale gas stations have yet to be The fuel price crisis has a far reaching impact
closed down completely, the returns were poor. The reaching beyond food prices because fuel is a basic
major factor contributing to the collapse of gas component of production and transportation.
stations was due to the government’s policy either Consequently many countries are facing a very difficult
directly or indirectly to prevent the price floating time. Mr. Ban Kee Mun, the UN Secretary General, has
according to the world market price.
warned the international community that if the food
In the mean time, passengers on all kinds of public price crisis remains, the problems will inevitably
transports including taxis, public buses, boats, private become more complicated and trigger further
buses, and cooperative buses, had to bear large problems, which will undermine economic and social
44 increases in fares, which were put up to accommodate development and security.
the rising oil prices. Trucks and fishing boats went on Similarly, the issue of food prices was an urgent
strike, demanding that the government supply cheap agenda included in the meeting between the World
fuel.
Bank and the International Monetary Fund (IMF).
Meanwhile private car owners flocked to get their Meanwhile the Asian Development Bank (ADB) had
engines altered so that they could use LPG, which was announced that the era of low food prices had come
about three times cheaper than gasoline. This resulted to an end.
in overload at car garages, even when the cost of Before long, the phenomena of food crisis affected
Thais’ daily life. There was a shortage of food,
particularly rice and cooking oil, which used to be
abundantly available in the market. These food items
have become incredibly expensive.
Amidst this chaos a big question being raised was
what went wrong with Thailand. The country known as
the biggest rice export country, but rice has no longer
available for domestic purchase. This prompted
the first manufacturing company to lay off its 700 People are unhappy: the poor must adjust
workers without warning. The incidence led the and fight the hardship
Ministry of Industry to examine closely the issues of It is feared that during the economic crisis, people will
dismissal of workers. During economic crisis many get more depressed. An ABAC Poll was conducted in
manufacturing companies will close down.
18 provinces asking respondents about the political
Until 30 December 2008, 47 factories, the majority of crisis, economic crisis, and social opportunities during
which were electronic parts manufacturing in the past 30 days (late January and early February
Ayutthaya province, laid off about 10,000 workers, 2009). It was found the economic crisis impacted
and 22 factories were likely to be closing down. In late on the food prices of 62 percent of the respondents,
February 2009, the Ministry of Industry released the careers of 58 percent, and job insecurity for 57
official data showing that during the period of 1 percent. About 51 percent of respondents were
January to 20 February, 163 factories closed down seeking work and moonlighting for additional income,
and about 17,474 workers were out of work. and about 50 percent felt that the crisis had somehow
Furthermore, 355 factories employing about 132,130 affected their living conditions.
workers, were highly like to terminate the employment Amidst the living cost crisis, low-income earners
of their workers. These workers can be classified into in Thailand have altered their behavior to reduce
two groups: 62,856 workers at risk of being laid off, spending on items, particularly non-food items such as
and 69,274 workers likely to get less bonuses or clothing and accessories, and entertainment expenses.
reduced working time. The majority of the affected Meanwhile, instant noodles, a Thai economic indicator,
factories produce garments, computers and electronic, have had huge increases in sales, even at increased
home products, metals, and automobile. The top five prices.
provinces with high numbers of laid off workers are The northeastern residents in a group called “I-san
46 Samutprakarn, Pathumthani, Ayutthaya, Bangkok, and People in 19 Provinces for Democracy”, released a
Chachoengsao.
petition urging the government to immediately respond
Although the fuel price has dropped rapidly since late to solve the economic crises, including the fuel price
2008, this seems to have had little effect on the high crisis, the rice price crisis, and high price of sugar.
price of goods. Almost all commodity producers, Delay in coping with these issues will be inevitably
including commodity manufacturing giants such as the lead to increases in other costs of living and will hurt
Uniliver and Sahapat, and retailers including food people in all walks of life. The group also urged the
venders, noodles venders, bakery, building government to resolve the farmers’ debt problem, and
construction shops, and agricultural shops, have ensure fair daily wages for low income laborers.
pointed to high costs of capital and other costs apart
from the cost of transportation. It is fair to say that
the government can only strictly control the public
transport and that the fares have been slightly
dropped due to cheaper fuel price.
Private universities were not affected by the economic
crisis in 1997 but they were badly hit in the 2008
crisis. Many undergraduate students have enrolled
According to this data, the average annual deaths in the South, particularly in provinces where the
from suicide in Thailand during 1998-2007 were insurgency was occurring, such as Pattani (1.2 per
4,442 per year. The suicide rate peaked at 8.6 deaths 100,000 persons), Narathiwat (1.4 per 100,000
per 100,000 persons, or about 5,200 deaths, in 1999, persons), and Yala (2 per 100,000 persons).
due to the economic crisis. However, the number of It is assumed that contextual differences between
suicide deaths dropped to 3,458 deaths, or 5.5 deaths the North and South can to some degree influence
per 100,000 persons, in 2007.
the people’s decision to end their own lives. However,
There are clear regional differences in suicide death we have yet thoroughly investigated how culture,
rates in Thailand. The North has the highest rate in religious and economic factors influence people’s
the country, particularly in Chiang Mai and Lumphun decision to commit suicide.
Provinces, where the suicide death rates were the 2008 The information Centre, Plan Division,
highest for 10 consecutive years, at 21.3 deaths per Department of Mental Health, has collected data on
100,000 persons in Chiang Mai and 21.4 in Lumphun. the number of deaths from suicide occurring in
The suicide death rate for the whole kingdom for
January to December 2007. The data were obtained
the average 10 years was 7.1 deaths per 100,000 from the Ministry of Interior’s death certificates. It was
What is depression?
Feeling sad or depressed can be a normal reaction when people lose someone or something they love or
are under stress. The situation is considered to be abnormal once the symptoms have worsened and
involve the body (loss of appetite, fatigue, lack of sleep, weight loss), mood (persistent sad, crying, loss of
interest or pleasure in activities), and thoughts (pessimism, worthlessness, hopelessness, though of death),
and other difficulty concentration and remembering, poor personal relationships. All these symptoms
inevitably affect the ability to carry out daily activities or work, which will impose a large burden on the
family and community and may eventually lead to suicide.
Someone with symptoms of depression is considered to have a psychiatric disorder. This disorder can be
treated by having proper care, visiting a psychiatrist regularly, and taking medication for at least six
months.
among those who lack coping mechanisms.
sleeping such as starving, restlessness
None the less the Political Stress Syndrome (PSS) is • Aggression, self destructive tendencies,
The danger signs of depression (see Box) are not without medical reason
meant to attract attention, but the depressed persons • Talking or thinking about death;
nevertheless may be signaling for help. If we pay giving significant belongings away to others
attention and keep a close watch over someone who • Talking about self harm; joking about or outlining
may be close to developing depression, we can a plan to take his/her own life
50 prevent the loss and reduce the number of depressed
persons committing suicide.
• Threatening or trying to harm
Stress relief methods
relaxing the muscle and repeating the process over
again for about 10 times. The contraction will increase
The Department of Mental Health has given advice on muscle tension and feelings of stress, while relaxing
practical ways to release stress. These methods are will release the tension. This relaxation technique can
focusing on the relaxation of muscles, which leads to be applied to any body muscle, for example, clenching
peace of mind.
hands and contracting arms, raising or curling
Contract and relax the muscle by sitting comfortably eyebrows, tightly closing eyes and shriveling the nose,
and contracting the muscle for about 10 seconds, then taking deep breaths and raising the chest, back and
shoulder, sucking the stomach and contract the pelvic
floor, raising legs and flexing the toes, and so on.
Deep breath using the abdomen diaphragm. Take a
deep breath slowly to puff up the stomach and hold
for a second, then exhale to flatten the stomach.
Basic meditation. Sit cross-legged or in a comfortable
sitting position in an quiet place and then concentrate
on breathing in and out.
Silent technique. Sit or lie down in a private place,
then close the eyes to avoid distraction and breath
slowly.
Besides taking care of yourself, you should also note
whether behavioral changes are occurring among
other people you know.
Difference
Price of
drugs after
CL policy
Generic
version
Patented before the government released its policy. Mr. Chaiya
(time)
says “The announcement of CL is satisfactory but
imperfect.” It needed to be reconsidered because it
Efavirenz
58
24
10
5.8
would affect Thailand exports. He continued criticizing
per month
per month
per month
Doctor Mongkon Na Songkhla of rushing to sign the
Lopinavir / 1,800
1,000
780
3
agreement right at the end of his term. Mr. Chaiya
Ritonavir
per year
per year
per year
totally ignored the fact that the government use of CL
Clopidogrel
3
1.3
0.04
75
on the 4 cancer drugs was far better handled and
Letrozole
7
2.2
0.1
70
transparent than that of the first 3 drugs, resulting in
the delay of the formal announcement to early 2008,
Docetaxel
900
450
37
24.3
not long before Doctor Mongkon Na Sangkhla stepped
Source: Suwit Wibulpolprasert, 2008.
down from his ministerial post.
Note: Erlotinib is under the procurement process. Imatinib is available for free for
income earner patients under the universal coverage scheme by using the model Attempts to review the CL by the new Minister of Health
drug from Novartis under the special project of the Glivec International Patient
Assistance Program (GIPAP).
led to widespread opposition from groups of patients,
In 2008, Thailand announced the use of CL professionals, NGOs
doctors, pharmacists, academics, and
on cancer drugs: lawful and satisfactory
52 Dr. Jiraporn Limpananon, Department of Pharmacy,
In early January 2008, Dr. Mongkon Na Songkhla, then Chulalongkorn University, stated that “A person who
Minister of Health, granted licenses to four anti-cancer oversees the Ministry of Public Health must protect
drugs:
Thais interest in access to drugs. If the reconsideration
1. Lung cancer drug with generic name Erlotinib and of CL ends up with the cancellation of CL, this
trade name Tarceva®
decision will affect Thailand as follows: 1. difficulties
2. Breast cancer drug with generic name Letrozole accessing drugs; 2. difficulties negotiating with drug
and trade name Femara®
firms, because Thailand no longer has the threat of
3. Lung and breast cancer drug with generic name CL, meaning that firms will not drop the price of
Docetaxel and trade name Taxotere®
drugs; 3. without CL, household expenditures on drugs
4. Medication for chronic leukemia with generic name would rise substantially”
Imatinib and trade name Glivec®
Opposition to the review of CL policy has not been
However, the government stated that it would not confined to Thailand, but has extended internationally.
impose CL as long as the pharmaceutical industry has party wrotemember Twenty-six of congress from the US Democrat
supplied the patented drugs free of charge to the opposing the aimposition letter to the US Trade Representative
of Special 301 Report to block
government universal health coverage scheme. an access to drugs among Thais. Meanwhile nine
Although the agreement was signed in January
international legal experts also wrote a letter to Mr.
2008, the implementation was to take a year, ie. until Chaiya and Mr. Samak Sundaravej, the Prime Minister,
Social Security and Civil Servant Medical Benefit joined force and shared their experiences. Treatment
would be charged at the existing price of 70 baht of terminal stage of kidney failure has been included in
per table. Many hospitals, impressed with the the universal health coverage and social security
offer, have requested that the Health Ministry beneficiary. Likewise, a network of cancer patients
clarify the CL policy.
initially formed by patients from several hospitals
• Criticizing the quality of generic drugs. Drug began to make their voice heard concerning the issues
companies release information on the quality of of access to drugs. Lately the network of mental
imported generic versions and Bioequivalent health patients has called on the government to issue
Studies (BE Studies) for imported drugs, aiming to compulsory licensing on psychiatric drugs.
discredit generics. This tactic combined with The movement by civil society is not only limited to
reduced drug prices has created great frustration the matters concerning continuation or cancelling of
among doctors. In fact, special attention has been compulsory licensing. It has also extended knowledge
paid to the matter concerning the quality of the on the universal access to drugs of all Thais, proposed
licensed patented drugs. These drugs meet the in the First Thai National Health Assembly. Strategies
standard set by the FDA and none of those claims include:
were substantiated. In addition, tests were 1. collaboration with the health network
conducted by the Department of Medical Science.
At present the licensed drugs have been 2. supporting patient groups to engage in health care
distributed to over 200 public, private and and health promotion
university hospitals nationwide, with no concerns 3. supporting efforts in setting national drug prices to
yet raised. In response to this issue, the FDA, in realistically reflect the cost of living
press conference, backed the quality of the 4. enhancing the development of pharmaceutical
licensed drugs such as Clopidogrel.
production in the country
• Enforcing rules trapping generics. The Department 5. maximizing the benefit or diminishing obstacle
54 of Intellectual Property, Ministry of Commerce, took from the use of law
the opportunity while raising concerns about pirate 6. encouraging proper use of drugs
CDs, to push for an Office of Prime Minister 7. research and development of new drugs
resolution dealing with the violation of intellectual
property rights … which also included more that 30 A number of international groups have drawn on
drafts from all organizations overseeing the Thailand’s experience with compulsory licensing. For
intellectual property of the private sector, including example, the Civil Society of Columbia has called for
FDA, which is responsible for the certification of the Columbian government to take a humanitarian
registered drugs for the consumer protection. As a stand over providing universal access to essential
result, the organization oversees consumer antiretroviral drugs such as Lopinavir and Ritonavir.
protection but also deals with intellectual property In China, the Chinese Intellectual Property agency
law enforcement. This is consistent with the invited the international law and pharmaceutical
demands of the US and EU for FTA negotiation and experts and Thai representative to discuss experiences
is an attempt to get generics classed as counterfeit in using flexibilities in intellectual property agreements
drugs in the WHO meeting with the leaders of including compulsory licensing. Without doubt,
Group of Eight or G8.
virtually every battle involvies resistance and hostility
as experienced by Thailand.
Beyond access to medicine, we also win
over people
The road ahead
Amidst this struggle between life and vested interests, The fight for balancing profits and access to essential
there is a a growth of civil society support for the drugs is far from settled. No single group is strong
implementation of compulsory licensing.
enough to win the fight. Only if all civil society and
patients join forces, raising public awareness in
The Thai Network of People Living with HIV/AIDS has recognizing the basic human rights to access to health
been a major force in taking a firm stand on universal care can the battle be won.
access to drugs. The Kidney Disease Association has
The student talked with her friends before telling her by the professor in the previous semester the
parents and reporting the incident to the police. The professor had asked for her mobile number. She had
56
case could not be prosecuted because of lack of thought that this that was a common method for
evidence. The police advised the student to hide a communicating with students.
tape recorder in her bag and go back to the teacher to The professor often rang her using flirtatious language
ask him about her mark. The teacher behaved the and asking for dates. She had never accepted his
same way and offered the student a good grade in offers and had avoided him. The professor had
exchange for having sex with him. After sneaking out threatened her that if she did not cooperate, she
from the teacher’s office, the student handed the tape would have trouble with her exam. After the exam she
to the police. The court then issued a warrant to found that all other students received A grades, but
arrest the teacher.
she received a very low mark. In the next semester,
The teacher was arrested in his office in the university she had to take a subject offered by the same
and was accused of committing immoral conduct. He professor. The professor took whatever opportunity he
was made to confess in front of the University could to verbally harass her, and make sexual
President. An investigation found that in the past one advances. The victim was forced to face the problem
female student was sexual harassed by the same alone. She contended that she went to see her advisor
teacher, but the student managed to escape. His and asked for an advice about the incidents but was
behavior was widely known among students.
told only to be careful and that nothing could be done.
Since the incident was disclosed to the public, Thais “Given no other way out, I decided to talk to the
witnessed an apology from the President of the police. The police suggested carrying a hidden video
University. He said that he regretted the incident, and camera to an appointment with the professor in his
that he apologized to the general public for not being office. As anticipated, the professor asked to see me in
able ot control his staff to properly. He said that the his office. I carried a video camera as planned. Once I
Incidents of sexual harassment reported in the print media in 2008 (16 incidents)
Published Harasser (province)
Victim
Situation
Date
14 January
Music teacher
Year 7 student (aged 12)
Rape in the music room
29 February
Thai language and computer Female student (aged While pretending to teach, approached from the back,
touched the genital area, and inserted a finger into the
teacher (Ratchaburi)
11) (since year 4)
vagina
29 February
School principal (Chonburi)
Year 7 student (aged 13)
Invited three students to his office, and touched their
bottoms and embraced them
24 March
Thai language teacher Year 7 student (aged 13) Entered the classroom and tried to physically harass,
(Khonkaen)
5 students
kiss, and rape; offered money
25 March
Year 4 student (aged 10)
Call
Physical Education teacher students to the physical education class and
(Singburi)
sexually abused them
28 March
Vocational teacher (Lampang)
Year 7 student
Sexually abused and made threats if victim disclosed
the act
Forced student to perform oral sex in exchange for 59
good marks. (Similar there incidents had occurred
24 April
University lecturer
student
earlier, including rape in a car causing a student to
become pregnant, dismissed*) but accusations and all
reports were
09 May
Physics teacher (Srisaket)
Year 12 student
(aged 17)
Told student that taking to buy uniform but instead
took to motel
Abused and persuaded to sleep with lecturer, in
29 June
University lecturer
Year 3 student
exchange for grades. The student used a hidden video
camera to take pictures used as evidence
06 July
Boxing teacher (Chantaburi)
Vocational student year Forced to go to a hotel and raped
1 (aged 16)
22 July
Principal of secondary school Secondary school Physical abused female students, touched breasts and
(Sakonnakorn)
student
bottom
30 July
Teacher (Phisanulok)
Year 8 student
Physical abuse and then bought gift in exchange for
not reporting the incident
08 October
Computer teacher (Chonburi)
2(aged
male students year 6 Kissed, told to take off trousers, and physically abused
12)
30 November
Principal
(Surin)
of Sport School 4 male student year 7 Physical abuse, coercion and touched penis. Gave
(aged12)
money to not tell others
13 December
Director
Mai)
of college (Chiang Year 12 student
Touched breasts and abused on the bus
24 December
Arts teacher (Chachoengsao)
Year 9 student (aged 16)
Sexual abuse for 2 years
* Other cases were raised in the seminar on ‘Sexual Harassment in University...problems and solutions’ organized by Program of Woman and Young Studies, Thammasat
melamine. With the melamine, the milk could pass the the melamine crisis. In mid-September 2008, the
standard test for protein content.
FDA began to request retailers and distributors to
The scandal unfolded on 12 September 2008 when the temporarily remove Chinese milk and diary products
Chinese government recalled milk products across the and food with milk ingredients. In addition, the FDA
nation for testing. The tests were prompted by one also ordered all ports to hold all shipments of raw
baby dying from kidney stones, and several babies dairy products from China for inspection, to ensure the
falling ill from the same disease. These babies had products were not contaminated with melamine.
been fed milk powder manufactured by the Sanlu Products were issued with a certificate before being
Group. Representative from Sanlu Group accepted that released into the market. The FDA also recalled and
some lots of milk powder produced before 6 August removed from shelves all Chinese milk and diary
2008 were contaminated with melamine. The company products that had been imported into the country
has recalled more than 700 tons of product.
before the melamine scandal, and ran tests on a
What is melamine?
Melamine is an organic compound that forms a white, renal failure. Symptoms in infants who were fed on
crystalline powder and is water soluble. It has a high melamine-contaminated milk include crying while
nitrogen level, equal to about 66% of its mass.
urinating, vomiting, pupil constriction or acute renal
If melamine is combined with formaldehyde, it produces failure, small stones in urine, high blood pressure, and
melamine resin or durable thermosetting plastic, which swelling. Most of the afflicted people are young children
is used for making melamine form, formica, glue, plate who were mainly fed on milk. These children received
and whiteboard.
much larger doses of melamine than adults, and their
Melamine has relatively low toxicity, but it is harmful if renal function was not fully developed.
swallowed, inhaled or absorbed through the skin in high In 2007, melamine was found in wheat gluten and rice
doses. Over long periods it can lead to kidney stones or imported from China for making pet food in the USA.
Many cats and dogs have died from renal failure.
Source : “Question and Answer about Melamine”. http://www.fda.moph.go.th/www_fda/fda_melamine/index-melamine.php
Table Summary of dairy products contained melamine above the standard level
Province. According to interviews with surviving boat as trafficking in persons, particularly in women and
people, they were pushed back into the ocean in very children, for the sex trade. This can be seen in the
dangerous circumstances and were harassed. This various inter-governmental agreements:
incident became a diplomatic crisis for the Thai • The 1999 Memorandum of Understanding on
government. After the incident, many media and the Common Guidelines and Practices for State
government officials have claimed links between this Agencies was concerned with Victims of trafficking
incident and current forms of human trafficking.
in women and children
As a result, this issue has received increasing • The 2003 Memorandum of Understanding on
attention from the government, the general public, Common Operational Guideline for Government
and civic society actors whose work is related to Agencies Engaged in Addressing Trafficking in
migrant workers.
Children and Women (Number 2); Memorandum of
Understanding on Operations between State
The link between human trafficking and Agencies and NGOs Engaged in Addressing
forced labour
Trafficking in Children and Women; and
Human trafficking is linked to forced labor. This Memorandum of Understanding on Operational
viewpoint is reflected in the government’s views on Guideline for NGOs engaged in Addressing
the deaths of 54 Burmese migrant workers. Mr. Trafficking in Children and Women
Noppadon Patama, Thailand’s Minister of Foreign • The 2003 Memorandum of Understanding between
Affairs has said that the “Thai government will be the Royal Thai government and the Government of
collaborating with the Myanmar government in the Kingdom of Cambodian on Bilateral
64 combating international human trafficking. At the Cooperation for Eliminating Trafficking in Women
moment the two governments are discussing the and Children and Assisting Victims of Trafficking”
possibility of drafting a Memorandum of Understanding • 2004, drafted the Memorandum of Understanding
against human trafficking and we are ready to tackle entitled “Cooperation of the countries in the
the problems concerning illegal migrant workers from Mekong Subregion against trafficking in persons
Myanmar followed the Memorandum of Understanding • The 2005 Memorandum of Understanding between
which both countries have signed.”
the Royal Thai government and the government of
The issue of human trafficking has been widely Laos PDR. on cooperation to combat trafficking in
recognized by the international community and by persons particularly women and children.
many national governments. Among ASEAN countries, The Prevention and Suppression of Trafficking in
human trafficking has received attention for over 10 Persons Act 2008, effective on June 2008, prohibits
years:
any forms of trafficking in persons including forced
• In 1997, the issues of women and child labour labour which covered trafficking in infants, children,
were raised for the first time in the informal women, old people, and men. This law lays down
ASEAN leaders meeting, which set guidelines and heavy penalties, equivalent to that of serious crimes,
collaborating procedure to solve regional problems which is different from the previous Act.
including women and child workers
• In 1998, ASEAN leaders approved the Hanoi Plan The death of 54 Burmese migrant workers as
of Action for cooperation in fighting trafficking in described earlier has led to arguments over whether
women and children and forced labour
these people were the victims of human trafficking. In
the end, the answer was that the incident happened
• In 2004, the 10th ASEAN Summit held in Vientiane before the new Act on the Prevention and Suppression
signed a declaration against trafficking in persons, of Trafficking in Persons was in effect. Nevertheless,
particularly women and children
there were people supporting both sides of the
argument.
9
AIDS threats Thai youth
การคาดประมาณสั
Estimated proportion ofดnew
สวนผู
HIVตinfection
ิดเชื้อรายใหม แยกตามกลุ
by population groups,ม1997-2010
ประชากร ป 2540-2553
1SFNBSJUBMTFY
8PNBOJOGFDUFE)*7GSPNIFSIVTCBOE
'FNBMFTFYXPSLFS
.BOJOGFDUFE)*7GSPNIJTXJGF
1MBZCPZ
.4.
*OKFDUJPOESVHVTFS
ZFBS
Source : Bureau of Technical Development and Support for HIV/AIDS Prevention, Department of Disease Control, Ministry of Public Health. 2008.
Youth Clinic’ in Bangrak Hospital in late 2007. It aims call centre at 1330 extension 4 every day at
to be a model clinic for the control and prevention of 16.00-22.00 hrs, or the website www.lovecare
HIV infection through the provision of voluntary HIV station.com. In cases of referring to further
testing and STIs test and treatment services for young diagnosis or treatment, present your ID card
people aged 10-24. The clinic operates every Saturday together with an access code from the call centre
at 9.00-15.30 hours. So far, young people are satisfied or the website to receive services free of charge
with the services and friendly staff.
at those 13 clinics. Your personal information will
be kept confidential at the clinic only and will only
According to WHO, HIV testing and prompt treatment If the policy is successful, it can help control and
with antiretroviral drugs in case of positive test, prevent HIV infections.
without waiting for lower CD4 levels, can save the Speed up promotion of condoms as part of
lives of 100 percent of people with new HIV infections. Thai sexual life, beginning with first sexual
Although the cost of this service is very high during intercourse
the first 10 years, the much higher cost of AIDS
treatment could avoided.
It is clear that the main cause of the HIV/AIDS
It is estimated that there are about 400,000 Thais epidemic in Thailand is unsafe sex. Unsafe sex is a
major problem in Thai society, because the rate of 71
with unidentified HIV infections, who are spreading condom use is very low at the first sexual intercourse
HIV to others. If people with these unidentified HIV particularly among youth.
infections are tested for HIV and receive early
treatment, there would be minimal adverse An analysis of research on sex, sexuality and AIDS
consequences on health and lowered treatment costs.
by Kritaya Archavanichkul and Kanokwan Tharawan
At present, young people aged less than 18 are (2008) revealed that the use of condoms is not part
increasingly vulnerable to HIV infection. The Medical of Thai sexual culture. Thai people, both men and
Council organized a meeting with working groups, women, have learned about sexual intercourse
networks, and organizations working on HIV/AIDS
without thinking of condoms. As a result, they believe
on 17 December 2008. The meeting aimed to have a that condoms will reduce sexual pleasure.
public discussion on the Medical Council Guidelines Therefore, public health campaigns must
for HIV testing in children and young people. The enhance knowledge about sexuality in Thai
meeting concluded that children under 18 years society. The campaigns should address non-
of age and not married can undertake an coercive or unforced sex, safe sex norms to
HIV testing without parental consent, but avoid contracting diseases or unplanned
must receive full counseling before and pregnancy, and promoting responsible sex
after the test.
as the basic foundation of every sexual
A survey was conducted among 1,998 youth relationship.
in 20 provinces on HIV testing. The survey Campaigns promoting a new sexual
found that 86.3 percent of youth knew that culture need to spread the message that
HIV testing was a prevention measure
responsible sex mean sex with a
and wanted to take the test. Seventy-eight condom. For oneself and for others, this
percent agreed with voluntary HIV testing is genuine safe sex behaviour.
without parental consent.
72
organized the assembly. It synthesized views and that the Secretary-General of the NHC submit NHA
recommendations proposed by the Area-Based Health comments to the committee overseeing the draft of the
Assembly, Issue-Based Health Assembly, and other Statute on National Health System, to be incorporated
forums. It also prepared an agenda to submit to the into the draft statute before submission to the NHC.
National Health Commission for further development The Statute will be widely publicized to inform the
into policy formulation, and to report back to the NHA public about the statute and to encourage government
in the following year.
agencies, professional bodies, academic, private sector
In selecting topics for inclusion into the NHA, the
committee encouraged submissions from stakeholders.
As a result, 68 proposals were submitted from about
50 organizations. The selection criteria of the
assembly were the urgency of the issue and the
breadth of its impact on the national citizens’ health.
Individuals or organizations, whose proposals were
selected, were appointed to review and document the
issues. The first NHA approved 12 topics and 2 urgent
issues, as priority topics for the healthy public policy.
More than 1,500 people, including 178 nationwide
delegations belonging to political parties, academic,
public agencies, private organizations, and civil society
organizations attended the first assembly.
appropriate health insurance scheme; to prepare a to social security scheme among informal workers.
work plan to accommodate primary health services It also proposed the development of networks for
every ten years; improvement of the efficiency and occupational health and working environment, and
management system of the three public health complaint mechanisms and centres for providing
insurance schemes by proposing a plan for reforming counseling. Government agencies should support the
health insurance scheme every five years to minimize provision of appropriate health services. Local 75
any discrepancies and enhancing efficiency.
administrative organizations should be encouraged to
9. Impact of media on children, young people and develop public healthy policies for informal workers.
families. The assembly agreed that government 13. Promotion the relationship between health
agencies should lobby for the setting up of a fund for providers and patients and their relatives. The
creative media production, to produce a wide variety assembly agreed to recommendations for policy
of media of all forms, such as computer games, and development to address the relationship between
public media that are appropriate for children, young health providers and patients and their relatives
people and families. Consumers were also encouraged through the following strategies: recognize of the
to participate in providing feedback and the urgent need for relationship-building in the health
production of creative media, promoting the creation system; develop mechanisms to improve the
of mechanism for media awareness, and strengthening relationship, such as draft legislation safeguarding
existing mechanisms for screening media products and patients from medical malpractice; developing a
advertisements which may have adverse health effects complaints resolution centre as a mechanism for
on consumers, especially children, young people, and settling conflicts in health services through peaceful
families.
means; promotion of friendly health services;
10. Sexual health: sexual violence, unwanted developing a medical legislation process; and reform of
pregnancy, and sex issues relating to HIV/AIDS and ethics procedures among health professional bodies.
STIs. Issues related to sexuality have been on the rise The NHC should set up participatory mechanisms for
and have become serious national public health monitoring and evaluation of the implementation of the
problems. The approved forum approved several recommendations within the Working Group for
resolutions regarding sexual health to strengthening National Health Resource Development.
society’s defenses and to raise awareness on sexual 14. Economic crisis and protection of the health of
health through a wide range of measures such
Thai people. The assembly recommended that the
as providing comprehensive sexuality education,
consensus”
The assembly was focused on significant issues under the slogan “using knowledge and consideration for
consensus”. Six issues were selected as a starting point: agriculture enhancing health, safe food for
sustainable health, public policy and environment, local wisdom on health, holistic health services, and
management of human resource in health. Important outputs included the establishment of a committee on
policy studies of the proposed resolutions, followed by the preparation of policy and strategy documents and
procedures to push forward the implementation process among relevant agencies. This led to a revision
process and the utilization of the policy.
2004: Stress on “Food and Agriculture for health: threats from chemicals”
Work this year focused on supporting Area-Based NHA, both at provincial and regional levels, and Issue-
Based NHA, particularly those concerned with children, young people, and disabled people. However, the
$VMUVSFPGWJPMFODF
52-07-053_080-113 new18_V-eng.in80 80 7/18/09 2:19:11 PM
52-07-053_080-113_V-eng.indd 81 7/15/09 6:23:25 PM
1 The World
of Violence
T he world has seen various forms of violence incurred by
humans, from fighting and killing between individuals or
groups to wars over power between countries. There is
also hidden violence which may not be clearly seen,
but its consequences can be felt. These incidences
happen repeatedly in our everyday life, to the
extent that sometimes we are not aware they
are violence.
The World Report on Violence and Health launched
by the World Health Organization (WHO)
indicates that every year more than 1.6 million
people from all walks of life die as a result of
82 violence. Much more have received physical
and mental pain inflicted by others or self-
abuse. Overall, violence is one of the leading
causes of death in adults.
In Thailand, violence is one of the 10 leading
causes of death according to the Bureau of
Policies and Strategies, Ministry of Public
Health. The number of victims of violence has
alarmingly soared. Children are suffering from
physical and mental pain caused by adults who
are supposed to care for and protect them.
Adolescents and youth in and out of schools are both
victims of violence in the forms of bullying, assaults, or
self-abuse. Some have fallen into the trap of abusing
drugs. Some are victims of crimes. Women are physically
and sexually abused by men, of whom many are intimate
partners. Elders, the fast growing group in the society, have been
abandoned or maltreated by their caretakers or their own children.
There are many other forms of violence caused by conflicts arising from
differences in languages, economic approaches, religions, political ideologies,
and social status.
and Diversity
Violence has a broad
J ew* a 34 year-old woman with a high school diploma
has been married for 8-9 years. Jew has a son and is
pregnant with her second child. Recently, she decided to
definition. It covers those
that are actions and
flee from a rented house she had lived with her husband
to stay with a rescue shelter for women because her those that are not, which
husband imprisoned her in the house for 3-4 years.
will or may affect directly
K ate* a 19 year-old girl, used to pursue higher vocational education. She didn’t look lively as
most girls in her age. Her relatively large eyes show tinges of anxiety and pain. She decided
to leave her parents’ house to stay in a rescue home. Kate was a victim of drug-facilitated rape
by a male friend. As a consequence, she was pregnant. Kate was so embarrassed that she did
not tell anyone about it. Finding herself pregnant, Kate told the friend and asked for his
responsibility, but he told her to get an abortion and left her. Her parents soon found out about
the pregnancy. She had to drop out of school. Disapproving of the incidence, her parents kept
scolding at her. Her dad beat her and accused her of tainting the family name. In the end, he
forced her to move out of their home. Today, Kate lives in the rescue home, but she doesn’t
know what will happen in the future. She has nowhere to go and no idea what she will do.
*False name
three southern most provinces in January 2007.
that violence has many forms and result from many
In 2006, while teaching in Bann Gujingrupa School, causes to the extent that it is difficult to clearly
Ra-ngae District, Narathiwas Province, she was held understand violence. Nonetheless, if we want to prevent
captive by a group of insurgents and was hit until or mitigate violence, we need to start by understanding
her brain was severely injured. Despite the medical what violence really is and what are the nature and root
team’s best effort to rescue her, Teacher Juling was causes of it.
in a persistent vegetative state. Thai people prayed
for her hoping that she would recover, but Teacher International Perspective
Juling passed away peacefully after eight months of In the World Report on Violence and Health, WHO
remaining in the critical condition.
defined violence comprehensively as “the intentional
Thailand has lost another great teacher due to social use of physical force or power, threatened or actual,
and political conflicts in which Teacher Juling was against oneself, another person, or against a group or
not involved. She is one of over 3,000 victims who community, that either results in or has a likelihood of
died from the unrest since 2005.
resulting in injury, death, psychological harm, mal-
development, or deprivation.” The use of physical force
also includes threats and intimidation.
Violence is not limited to using physical force or arms,
but it also includes exercising “power” against others. Physical assault resulting in injury or death is no doubt a form
of violence. However, using power to force others to do what they do not want to or to prohibit them from doing what
they have the right to do is also considered violence; for example, a husband imprisoning a wife in their house (Jew’s
case above), a teacher using his authority to force a student to have sex with in exchange for a better grade, or a
supervisor using unfair judgment to order a shift in a subordinate’s position as sometimes reported in the news.
In this perspective, violence causes gaps or 3) psychological violence including verbal or physical
differences between the potential capacity of violent acts that leads to victims’ psychological
individuals, communities, and societies; and their suffering, anxiety, or depression; and 4) rights violation
real situation.
through discrimination or hindrance to basic rights to
which an individual is entitled.
The Dependent Origination
violence is both cause and effect in itself. A form of of direct violence, structural violence, and cultural 87
violence may be an effect of another existing form of violence.
violence and at the same time, it can cause another
form of violence. For example, inequality is deemed Direct Violence is an act (or non-act) which results in
social violence which may be caused by an unfair oneself or other’s physical or psychological injuries. It is
income distribution policy which is also a form of the type of violence with which we are familiar. We can
violence called structural violence (see the next section). easily identify the perpetrator, the victim, the injured,
At the same time, inequality can lead to other types of and how severe the injury is. Examples of direct
violence such as poverty and health problems of violence include a husband beating a wife, a teacher
underprivileged populations. This example illustrates hitting a student, a woman suffering from sexual abuse,
how violence ‘reproduced’ itself and remains prevalent.
gangs of teenagers fighting in a concert event,
This is ‘ ’ or the dependent origination
demonstrators clashing with government officers. Direct
of violence, the process in which violence relies on violence is obvious appearing at the surface level. What
another violence to emerge. Simply put, when one thing appeared on newspapers is mostly direct violence.
exists, another thing, therefore, exists. When one thing
happens, another thing then happens. This process Structural Violence is violence incurred form unfair
enables us to stop violence by eliminating the root cause policies, laws, political and economic systems. It also
of violence. For instance, if we could eliminate structural includes centralized political and economic power which
violence, other types of violence will decline.
causes “damage” on people or certain groups of people
in certain areas by rights violation, discrimination,
Diverse and Complicated
exploitation, suppression, and prevention from access to
resources and life necessities. This leads to poverty,
Violence comes in various forms. To make it simple, we gaps between the rich and the poor, and social conflicts,
can categorize violence as (1) self-directed violence which often result in violence in the forms of resistance
such as suicide or self-mutilation; (2) interpersonal and conflicts between the people and the government
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and traditions give power to husbands over wives).
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are inseparably interconnected among all forms
reduce violence in the society, we must deal with
of violence. For example, the act of rape constitutes factors at all levels so that they are not supportive of
direct violence (a man using his physical power to force violence. This is extremely challenging.
a woman to have sex with), structural violence (loose
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An Inconvenient Truth
lthough we do not want to
hear about it, we cannot
Suicide and Homicide: A Problem Common with
Men
refuse that many forms and levels Information compiled and analyzed by the Health Information
of violence exist in Thai society. Branch of the Bureau of Policy and Strategy, Ministry of Public
Below are only some examples to Health, shows that in five years (2003-2007) suicide (self-violence)
and homicide (interpersonal violence) combined are one of the 10
illustrate the severity of violence. leading causes of death in Thailand. It has held 8th or 9th rank for a
These examples include fatal long time. In the reporting period, suicide and homicide accounted
abuse (suicide and homicide), for 11-15 deaths per 100,000 people. This excludes death from
sexual violence, domestic violence,
accidents and poisoning, which is ranked 2nd among the 10 leading
causes of death, and has been for so many years.
youth violence, abuse of the
elderly, and structural violence According to the statistics in 2007, suicide caused more deaths
than homicide, accounting for 6 deaths per 100,000 people, higher
including political and economic than 5.5 deaths resulting from homicide. These two causes
violence.
constituted approximately 2 percent of deaths from all causes.
90 Ten most important Causes of death among Thais per 100,000 people, 2003-2007
Causes of death
2003
2004
2005
2006
2007
All cancers and tumours
78.9
81.3
81.4
83.1
84.9
Accidents and poisons
56.9
58.9
57.6
59.8
56.7
Heart disease
27.7
26.8
28.2
28.4
29.3
High blood pressure and blood clots in the brain
34.5
34.8
29.2
24.4
24.3
Lung infections
23.9
26.3
22.4
22.0
22.5
Kidney disorders
19.2
18.6
20.2
20.6
21.5
Diseases related to the liver
13.0
12.0
14.6
14.4
13.9
Suicide, homicide and others
14.8
11.7
11.8
11.1
11.5
Viral infections affecting the immune system
26.8
18.3
12.8
10.5
8.8
Tuberculosis
11.0
9.7
8.9
8.3
7.7
Source: Health Information Division, Bureau of Policy and Strategy, Ministry of Public Health
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which abruptly changed many people’s
lives. Those that could not adjust to the
situation might have been under extreme
stress and depression and, as a result,
possibly committed suicide.
At the regional level, deaths from violence
significantly vary. In 2008, excluding
Bangkok, in the South, death rates from
4PVSDF)FBMUITUBUJTUJDT
murder were the highest (22 persons per
100,000 people), in the North the suicide
rate was the highest (10 persons per 100,000 people),
while rates of both causes in the Northeast are the %FBUISBUFGSPNTVJDJEFBOEIPNJDJEF
lowest. This may demonstrate a difference of society and CZSFHJPOQFS
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culture. Only in Bangkok, a big city and more developed
in every field than other regions of the country, the
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regions. This issue is unexpected because normally, life
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of the woman
8. Masturbating in front
of the woman
9. Stalking
Without the agreement of the woman
Source: Kritaya Archavanichkul 2008.
There are obvious differences between males and than women. The same age group of males had a rate
females and between different age groups concerning of injuries twice that of the next highest age group
violence. The majority of deaths from violence, namely 30-44 years. With such a high rate of injuries, it is
92 from homicide and from suicide, occur among men; the important that society should focus on this young group,
rate is approximately four times higher for men than for so the levels of violence can be reduced.
women. The highest numbers of deaths from violence
are in the age group 15-59 years, working age people, Sexual Violence: Women are Perpetual
but, the highest death rates from suicide are among Victims
elderly (age 60 years up), while the highest rates of
murder are in adolescents and the working group age Sexual violence covers all forms of behaviour that has a
between 15-59.
sexual intent and in which the person who is the target
does not agree or consent. Or the person may agree to
However, death rates from violence that are presented a future action, but when the act takes place they are
are only one part of all violence and perhaps just a unwilling to accept the action (due to a violation of
minority part. For a more completed picture, we should standards, tastes, immorality or because of health
also consider the injuries due to violence because the problems). Such behaviour could be a form of assault,
injury (particularly the physical injuries that require verbal harassment, harassment through eye contact, or
medical care) is a major public health problem.
through physical contact all with a sexual connotation.
For example, in 2004 statistics on injuries caused by The key of this issue is that the other party (which is
self-injury and being harmed (excluding other causes usually a woman) is unwilling to accept or is not ready
such as accidents) totalled 189,016 persons, for this behaviour.
representing 16 percent of all injuries which 4 percent But the term, “not ready”, is an important provision and
was from self-injuries, another 12 percent was harmed which is very difficult to interpret. This is especially the
by others. Women inflicting self-injuries were about two case when placing this type of violence into the context
times more than men, but men were injured by others of legislation, as it is difficult to find evidence to prove
about 5 times more than women.
that the person was not ready. Further, in many cases
Among adolescents and young people aged between
there is indirect forcing, based on the superior social
15-29 years, men were injured about eight times more status of the perpetrator. This is typical of sexual
violent sexual acts between couples (whether as over the past 10 years indicate that sexual violence
husband and wife or in any other relationship) and is increasing over time. In 2007, there were 5,269
sexual blackmail through the taking of photographs, or reported cases of sexual crimes (rape, sexual assault),
video clips.
which on average means 14 people every day, or one
ever 105 minutes was raped.
Sexual violence can occur in every type relationship, not
just people of the opposite sex but between same sex Although, the number of reported rape cases has
partners. This type of violence can occur between increased over time, the number of arrests has not
strangers who have never known or seen each other increased. During 1997-2001, the number of arrests
before or from a person well known, such as friends, was quite stable. However, from 2002-2007, the
pupils and teachers, husbands and wives, fathers and numbers decreased. This significant reduction can not
children etc. Those perpetrating this sexual violence
be explained by the available data. However, a change
can be of all ages and sexes, and can be individuals
in the responsible agency or an adjustment in a
or groups.
definition may be the cause of the decline.
Due to the complexity of the problems, to tackle sexual Another source of information that can be used to
violence is a great challenge.
assess sexual violence is news reports and articles that
are published on the internet. The diversity of stories
Situation assessments on sexual violence have been published by the media reflects the level of concern that
limited, unlike suicides, self-harming and murders. This society has towards sexual violence.
is because most of the act of sexual violence is invisible 93
and most victims do not want to reveal themselves. A survey and analysis of news reports and articles by
Thus, there are no complete sets of data indicating
the Institute for Population and Social Research, Mahidol
the true extent of the problem. Thus the 1997-2007 University in collaboration with the Women’s Health
statistics of the Royal Thai Police on the number of Advocacy Foundation under the support of the Thai
Health Promotion Foundation concluded that sexual
violence in Thai society has increased both in the
/VNCFSPGSFQPSUFETFYVBMBCVTFDBTFTBOE quantity and in the level of severity. Between 1998 and
UIFQFSDFOUBHFPGBSSFTUT
2007, there were 17,529 reported cases about sex in
DBTFT QFSDFOU newspapers and on the Internet. Some of these cases
may have been double-counted due to the database
management and different sources referring to the same
act.
From the 17,529 cases the most reported story about
sex was about violence, including rape (38 percent),
other forms of sexual violence i.e. prostitution, women
trafficking and deception (26 percent) and abortion (5
percent). The rest of the cases included stories about
reproductive health, sex education, sexual diversity,
gender relations and issues related to sex and the
:FBS
media, which combined accounted for 31 percent of all
reports.
1PMJDFSFQPSUT BSSFTUFE BSSFTUFE Currently, there is no other form of sexual violence that
4PVSDF%JWJTJPOPG%BUBBOE*OGPSNBUJPO
0GGJDFPGUIF/BUJPOBM1PMJDF'PSDF is as problematic as rape given the dramatic increase in
(extreme stress or depression resulting from family the Association’s Emergency Home were sexually
problems, husband’s undesirable behaviours, or abused. For example, they were pregnant from a
husband’s having another woman) and sexual abuse boyfriends or partners who did not take responsibility
(unwanted or forced sex). These abuses were usually for the pregnancy or later abandoned them.
One-stop Crisis Centres
The number of children and women receiving help from
the ‘one-stop crisis centres’ is increasing each year. As
One-stop crisis centres – known officially as Crisis a result of the increasing number of hospitals involved
Centres for Child Abuse and Violence against Women in the project in 2007 there were on average 50 cases
were established in 1999. Since then, the one-stop crisis per day, or on average 2 people every hour who were 97
centres have become a pilot project and such centres receiving support from these centres. This figure is likely
have been established in 23 different provinces. Each to be an under estimation of the real need, as there is
centre has a team consisting of a doctor, a nurse, a likely to be many other women and children who are
psychologist, a social worker, a representative from the victims of violence, but who did not seek assistance
private sector and a police officer. This team provides from the one-stop crisis centres, or from a police
both physical and psychological care, a safe place to station. The simply kept it silence because of shame or
stay and financial and legal assistance.
because they did not want the perpetrators who were
On the 12 of August 2004, to celebrate the auspicious members of the family to be in trouble.
occasion of her Royal Highness Queen Sirikit’s 6th Royal
Cycle these centres were given the name “one-stop
crisis centres”. The number of hospitals involved in the Number of child and female victims of violence
project was increased to 104, increasing the number of receiving assistance from the one-stop crisis centres,
provinces involved in the project. Further, a national 2004-2007
hotline with the number 1669 was established.
Number of Number
and
of child
women Average
The Ministry of Public Health is expanding the one-stop Year
hospitals victims of (cases/day)
crisis centres and it is planned that by 2014 there will with cases
violence
one such centre in each government hospital throughout 2004
70
6,951
19
the country. This will include such centres in 729
community hospitals, and in 9,760 community health 2005
109
11,542
32
centres. This will enable victims of violence to easily 2006
110
15,882
44
access services. It will also enable such services to old
people who are victims of violence. Further, the centres 2007
297
19,068
52
will provide protection and be vigilant against all forms Source: The Division of Health Service Promotion, Ministry of Public Health
of violence.
and violence embedded in social and cultural structures
allow opportunities for adults (parents, teachers) and
the society to abuse children but are not deemed as
violence or abuses. These include whipping,
TPNFUIJOHJOUIFJSNPVUI
forms by their fellow students in the past two
months prior to the survey. In general, violence
happened to male students slightly more than
their female counterparts. However, looking at
violence by grades, both male and female
students have equal opportunity to be exposed 4PVSDF4PNCBU5BQBOZB
Comparison of provinces with high risk and provinces with low risk, 2007
National
Rayong
Sakorn
Payao
Satul
100
Samut
Risk factors
Number of factories
2,129
4,709
267
435
126,804
Number of entertainment centres and brothels
410
197
52
63
13,833
Internet cafes in cities (per 100,000 people)
50.2
37.8
6.0
34.1
29.2
Number of risky sites in the province (per 100,000 people)
45.0
116.8
16.7
34.1
50.8
Indicators of violence (per 100,000 people)
Number of attempted suicides among children
74.1
61.4
13.1
46.3
40.2
Number of children from motorbike accidents (per 100,000 people)
2,308.9
3,286.7
334.3
2,644.5
1,669.6
Children 18 and younger who have been sexually abused
4.0
50.02
43.2
63.2
39.2
(per 100,000 people)
Number of children sent to detention centre (per 100,000 people)
111.4
106.2
80.9
28.8
64.5
Number of children sent to a drug rehabilitation centre
19.2
78.9
287.3
40.2
111.4
(per 100,000 people)
Source: - The number of factories is based on the Industrial Information Centre – Department of Industry (2007).
- Information about the number of entertainment centres and brothels is based on the Department of Communication Disease Control,
/VNCFSPGDBTFT
acts of violence against others. From a
social perspective, this is an issue of
concern as it directly impacts the future of
the nation.
taking place, child abuse indicators are
also high. These include children trying
to commit suicide or being admitted to 4PVSDF#VSFBVPG*OGPSNBUJPO
0GGJDFPG$IJMEBOE:PVUI+VTUJDF
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rehabilitation centres.
• Violence by Children
Children are not only victims of violence, but can also who were charged for a crime and does not include
be the cause or originator of violence themselves. This those who were not caught or charged.
101
has existed for a long time and still a solution for which Another form of child and youth-related violence is
needs to be identified. This comes in the forms of students from different schools fighting each other,
improper behaviours, fighting, physical assaults, gang which has been an issue of concern for the society at
violence, crime, sexual misconducts, drug addiction, large. However, the society has hardly done anything to
gambling, motorbikes races and video games.
prevent or reduce the degree of the problem, except
Despite social awareness of the issues, these different posing questions or insulting these violent acts when
forms of violence seem to be increasing both in terms of one incident makes the headline, and requesting those
numbers and complexity. Data on the number of concerned to take actions. As the news fades away, no
children admitted to rehabilitation centres during 2004 further actions are taken and the problems remain. As
– 2007 confirms an increasing trend in children time passes by, these problems develop in new forms
inflicting violence. Some rapidly increasing forms of which reappear too fast for the society to keep pace
violence include charges relating to property and with.
belongings (snatching, robbery and theft), those related Violence by students involves physical assaults as a
to drugs (consumption and dealing) and those relating to result of quarrels or personal hatred that is not
life and physical safety (physical injury and killing). associated with the school they attend, and violence
Looking at this violence for children by category, the associated with their educational institution. This latter
number charges for crimes on property and belongings form of violence reflects the reality that violence has
increased from 8,886 to 14,764 cases in five years (an shifted to the level of being institutionalized that passes
average increase of 13.2 percent per year), drug on from one cohort of students to the next. Behind this
charges increased from 5,897 to 10,279 cases (an violence is somewhat an “institution-crazed cult”.
average of 14.9 percent per year) and physical charges
increased from 4,843 to 7,784 cases (an average of This institution-crazed cult carries a common belief that
12.1 percent per year), all over the course of five years. everyone shares the same identity and this identity is
It is important to note that this data is only for those tightly associated with the institution which they revere
implemented centralized policies. The result has been In 2003, a survey by the Assumption University
the oppression and the discrimination of others, whether in conjunction with the Family Network Foundation, The
the difference is based on language, religion or culture, Foundation for Child Development and the Thai Health
creating conflict, suspicion and hatred flaming violence.
Promotion Foundation (ThaiHealth) found that most
Violence in three southern border provinces will children spent a large proportion of their time watching
continue as long as the measures are unable to TV. From Monday to Friday, children spent on average
resolve the fundamental causes of the violence.
3.5 hours per day watching TV, but on the weekend this
increased to 5.5 hours. Children are sitting in front of
the idiot box longer and longer.
The media brings us good and creative content but also
content which is violent. Sometimes we realize that the
the children’s thoughts and behaviours. Over the last 50 of violence, as it can influence children’s inappropriate
years there have been numerous studies from the West sexual behaviour. This type of media can easily
showing how violence in the media makes children more be accessible today, especially in the form of television
aggressive.
dramas, pornographic VCDs, cartoons, music videos,
websites and even advertisements. However, it must be
The violence shown in the media would not be that stated that the media is not the only factor to influencing
different from the violence children see in real life. The children and adolescents to have inappropriate sexual
violence seen by children and adolescents influence their behaviours, but it is an important factor. An ABAC poll
attitudes, emotions, beliefs and behaviours. Research of secondary school students in grade 7 to 12 in
from western countries suggests that violence within the February 2009 found that 13 per cent of students had
media has a major impact on children in at least three sex and 10 per cent of them said that sexual movies
ways: (1) it make them feel that violence is scary (2) it and pornography on the internet and on VCDs had
teaches them the different forms of violence and how to influenced them.
create it. This leads them to easily undertaking
aggressive behaviours (3) it makes them feel indifferent It can be seen from the numerous conferences,
to violence, so that they see it as something that is seminars, academic papers, and reports on the internet
common.
that Thai society for a long time has been worried about
the negative consequences of the media. However, little
The first two impacts may lead to avoidance or has been achieved to counter the problems. The problem
acceptance of violence by children depending on the is it is difficult to control the production and
surrounding factors. But it is of great concern that the presentation of such materials. Further, there is no
media is teaching children to be indifferent to violence. research showing whether TV classifications have a
This plus the knowledge of how to create violence (point positive impact or not.
Well-being
ell-being is a state in which there is
a perfect balance of physical, mental,
Injuries and death from violence cause two major losses
to the national economy. One is expenses for medical
care and the other is a loss of productivity. In 2004 the
social and spiritual conditions in a holistic Health Information System Development Office report
way. But violence hinders, decreases or indicated:
suppresses these conditions. So we can
- Injuries and deaths from self-mutilation and
say that violence is a threat to well-being, assaults cost 33,000 million baht in economic
both directly and indirectly, for individual, loss
family, community and society at large.
- More than 90 percent of this economic loss,
approximately 31,000 million baht is caused
The loss from violence that causes injury or death is by reductions in productivity. This loss is 4.7
tangible. It can be illustrated in terms of disability- times higher for men than women
adjusted life year (DALY). Public health scientists call
the loss to the disability-adjusted life year as the
“burden of disease”, which is the measure of loss to the
overall population. In addition to losses in the form of
the burden of disease, public health scientists have been 109
able to measure the loss resulting from violence to the
national economy.
Burden of disease
The report on “the Loss of Disability-Adjusted Life
Burden of disease is a holistic health index that
Year due to Violence in Thailand in 2004” by the combines time lost due to both premature mortality
International Health Policy Program (published in and non-fatal conditions. For a disease or health
September 2007) calculated that violence leading to condition it is calculated as the sum of the years of
death and injuries reduced the “DALY” by 270,000 life lost due to premature mortality (YLL) in the
years. This loss accounted for 2.7 per cent of all disease population and the equivalent healthy years lost due
burden of that year in Thailand.
to disability (YLD) for incident cases of the health
condition.
Loss from deaths and injuries resulting from violence is
greater for males than for females. In 2004, the male The loss of healthy life due to non-fatal health
population lost approximately 220,000 years from their conditions requires estimation of the incidence of the
“DALY” or 3.8 per cent of all losses from all illnesses health condition (disease or injury) in the specified
time period. For each new case, the number of years
and deaths. While for the female population the lost was of healthy life lost is obtained by multiplying the
approximately 56,000 years or 1.3 per cent of all average duration of the condition (to remission or
injuries and deaths.
death) by a severity weight that measures the loss of
Comparing the loss in “DALY” from self inflicted injuries healthy life using an average health state weight.
and suicides with harm inflicted on others, the loss from
self inflicted injuries is greater.
Source: Based on Burden of Disease and Injuries in Thailand: Priority Setting
for Policy. The Thai Working Group on Burden of Disease and Injuries,
Ministry of Public Health, November 2002.
Disability-adjusted life years (DALYs) caused by violence within the Thai population, 2004
Males
Females
Total
% of years % of years % of years
Cause/violence
Years of life lost from all Years of life lost from all Years of life lost from all
lost (YLL)
causes of lost (YLL)
causes of lost (YLL)
causes of
violence
violence
violence
Deaths/injuries/disabilities
5,716,465
100
4228,613
100
9,945,078
100
From all types of violence
215,732
3.8
55,937
1.3
271,669
2.7
Cases caused by the 107,206
1.9
37,092
0.9
144,298
1.5
person him/herself
Cases caused by others
108,367
1.9
18,845
0.4
127,212
1.3
War
156
0.0
0
0.0
159
0.0
Source: Based on the Office of International Health Policy and Program 2007.
one strategy, a one-fit-all system. The potential solution should be holistic strategies that
give priority to intervention that can bring about changes at the individual level, within
relationships, for the community and for the society simultaneously.
“สงครามการเมือง-สงครามกลางเมือง”. Matichon Weekly. อีกครั้ง”. Thailand Official news and information. (18
Vol. No. 1448 (16-22 May 2008).
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“สงคราม (กลาง) การเมื อ ง ต่ า งชาติ ล ดเครดิ ต ประเทศ
สยามประเทศ ungovernable”. Matichon Weekly. Vol.
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No. 1464 (5-11 September 2008).
Department of Juvenile Observation and Protection
“Yes หรือ No ก็ไม่ OK”. Matichon Weekly. Vol. No.1410 “Number and percentage of juvenile in narcotic
(24-30 August 2007). cases handle” in Annual report: case statistics. Data
and Information Group, Office of Juvenile Justice
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System development.
Social Research Institute. Chulalongkorn University. Kulapa Vajanasara and Krittaya Archavanijkul.
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youth in Juvenile Observation and Protection United Nations Development Programme (UNDP).
Centers. Article submit on The 5th Seminar on the December 2008.
Epidemic of Drug in Thailand Connecting Global Manorat Supatrahatrungsri. 2006. Finding ways
Research Networks on Substance Abuse by The to prevent and solve drug problems in Thailand.
3. Food crisis and fuel price crisis: the poor ต่อประชากรแสนคนจำแนกตามจังหวัด ปี พ.ศ. 2550”.
suffer the most
Available from http://www.suicidethai.com
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“ผู้หญิงฆ่าตัวตายมากกว่าผู้ชาย”. Daily News (10 June
2008).
“เกาะติ ด สถานการณ์ เ ลิ ก จ้ า งปี ’ 52 ตั ว เลขคนว่ า งงานพุ่ ง
“เผยพิ ษ การเมื อ ง ทำฆ่ า ตั ว ตายพุ่ ง ”. Daily News (26
เกินล้าน”. Matichon Weekly. Vol. No. 1477 (5-11 November 2008).
December 2008).
“คนไทยปรั บ นิ สั ย เลิ ก กิ น หอมมะลิ กิ น ข้ า วแค่ พ ออิ่ ม ”. “เพ้อ-เหงา-เศร้า-ซึม สัญญาณเสี่ยงฆ่าตัวตาย”. Naewna.
Dailyworldtoday. 21 April 2008).
(12 August 2008).
“คนไทยปรั บ ตั ว ลดความฟุ่ ม เฟื อ ยรั บ มื อ เศรษฐกิ จ ชะลอ “วิกฤติคนไทยปี 52...โคม่าหนัก เสี่ยงต่อสุขภาพจิต-เพิ่มการ
ตัว”.Kaosod. (28 December 2008).
ฆ่าตัวตายสูง”. Naewna. (30 December 2008).
“คนรากหญ้ า หนี้ ท่ ว มหั ว เฉลี่ ย 2.1 แสนบาทต่ อ ราย”. “ส่งท้ายปี วิกฤตสุขภาพจิต บทเรียนคนไทย ปีฉลูเน้นสร้าง
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(31December 2008).
government introduces compulsory
“ปั๊มน้ำมันเล็กทยอยปิดตัว”. File News. Matichon Weekly. licensing (CL) based on the right to life
Vol. No.1442 (4-10 April 2008).
117
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Overseas. Matichon Weekly. Vol. No. 1443 (11-17 Naewna, 7 February 2008
April 2008).
Prachatai, 17 March 2008
“วิฑูรย์ ปัญญากุล ชำแหละฟองสบู่ข้าว”. เรื่องจากปก. Green Manager, 26 March 2008
World. Vol. No. 99 (July-August 2008).
Krungthep Turakij, 11 March 2008
“New Deal แก้ วิ ก ฤตอาหาร ข้ อ เสนอจากธนาคารโลก” Matichon, 10 April 2008
Matichon. (7 April 2008).
Matichon, 10 June 2008
“ADB ชี้โลกหมดยุคอาหารถูก”. Dailyworldtoday. (23 April Manager, 13 June 2008
2008).
Prachatai, 6 August 2008
“สกู๊ปหน้า 1”. Thairath. (12 January 2009).
Manager, 16 August 2008
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Turakij. (24 February 2009).
Bangkok Post, 7 February 2009
“มึน! น้ำมันลดของกินแพง กระทุ้งพาณิชย์อย่าทำเป็นลืม/
ศึ ก ษาหญิ ง เข้ า พบ” Krungthep Turakij ( 25 April 10 ต.ค. 2008 ฝ่าฝืนลงดาบเด็ดขาด”. Komchadluek.
R (Eds.). 2002. World report on violence and health. tabid=322], 5 March 2009.
low (1 point).
and issue oriented. The types alternate each year. The
topic is sometimes selected from the 10 health issues.
The ranking data were analyzed
using the SPSS statistics package. Important criteria in selecting the topic special include:
Issues with high mean scores • Political significance
were given high priority.
• Importance to public
• The existence of diverse views and dimensions
The final decisions on what to
include were made by consensus Working process
among members of the Steering 1. The Steering Committee met to select the topic
Committee for the Thai Health 2. The working group outlined a conceptual
Report Project.
framework for the report
3. Experts were acted to act academic advisors
4. The working group compiled and synthesized the
contents. The contents were thoroughly checked
for accuracy by academics and experts.
5. The report was revised in line with reviewers’
suggestions.
Experts Health Indicators: Health Care Systems
1. Dr. Viroj Tangcharoensathien
International Health Policy Program (IHPP)
2. Dr. Phusit Prakongsai
International Health Policy Program (IHPP)
3. Dr. Thinakorn Noree
International Health Policy Program (IHPP)
4. Walaiporn Pacharanarumol
International Health Policy Program (IHPP)
5. Dr. Pinit Faramnuayphol
Health Information System Development Office (HISO)
125
Special Advisor: Violence
1. Phra Paisan Visalo
Wat Paa Sukhato Tambol Bann Tamafaiwan,
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